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자료유형
학술저널
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저널정보
대한중환자의학회 Acute and Critical Care Acute and Critical Care 제28권 제4호
발행연도
2013.1
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300 - 308 (9page)

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Background: The aim of this study was to examine the efficacies of somatosensory evoked potential (SEP) and diffusion-weighted magnetic resonance imaging (DWI) in predicting the clinical prognosis of comatose patients following cardiac arrest. Methods: Forty-one patients resuscitated from out-of hospital cardiac arrest (OHCA) were retrospectively studied. After return of spontaneous circulation (ROSC), SEP was conducted between one and three days after resuscitation, and DWI was conducted within five days of resuscitation. SEP was classified into three grades: normal, delayed conduction or unilateral loss of the N20 peak, and bilateral loss of the N20 peak. Bilateral loss of the N20 peak was considered a predictor of poor prognosis. For DWI, diffuse signal intensity (SI)abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex was taken as a predictor of poor prognosis. For patient clinical prognosis, the Glasgow-Pittsburgh Cerebral Performance Category (CPC) was used to evaluate neurological results at the time of discharge. Resulting CPC scores of 1 and 2 were considered as a favorable prognosis, and scores of 3,4, and 5 were considered as a poor prognosis. Sensitivity, specificity, positive predictive value, and negative predictive value for the prediction of poor prognosis were analyzed for each test individually and for the combination of the two tests. Results: Among the 41 subject patients, 31 underwent SEP, 30 underwent DWI, and 20 underwent both tests. The prognosis predictor of SEP (bilateral loss of the N20 peak) predicted poor prognosis with 56.5% sensitivity, 100% specificity, 100% positive predictive value,and 44.4% negative predictive value. The prognosis predictor of DWI (diffuse SI abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex) predicted poor prognosis with 85% sensitivity, 100% specificity, 100% predictive value, and 76.9% predictive value. For patients who underwent both tests, the sensitivity and negative predictive value for the prediction of poor prognosis increased to 92.3% and 87.5%, respectively, and the specificity and positive predictive value were maintained at 100%. Conclusions: The accuracy of poor prognosis prediction for patients in prolonged comas after resuscitation is enhanced by combining the results of SEP and DWI along with the individual results of each test.
#cardiac arrest #coma #diffusion-weighted magnetic resonance imaging #somatosensory evoked potential.

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참고문헌 (26)

참고문헌 신청
Yamada T / 2004 / Fundamental principles of somatosensory evoked potentials / Phys Med Rehabil Clin N Am 15:19~42 google schola Barrett KM / 2007 / Brain injury after cardiopulmonary arrest and its assessment with diffusion-weighted magnetic resonance imaging / Mayo Clin Proc 82:828~835 google schola Arbelaez A / 1999 / Diffusion-weighted MR imaging of global cerebral anoxia / AJNR Am J Neuroradiol 20 : 999 ~ 1007 google schola Bassetti C / 1996 / Early prognosis in coma after cardiac arrest: a prospective clinical, electrophysiological, and biochemical study of 60 patients / J Neurol Neurosurg Psyc google schola Booth CM / 2004 / Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest / JAMA 291 : 870 ~ 879 google schola

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