• Maenia Scarpino, Francesco Lolli, Giovanni Lanzo, Riccardo Carrai, Maddalena Spalletti, Franco Valzania, Maria Lombardi, Daniela Audenino, Sara Contardi, Grazia CelaniMariaMUO Neurofisiopatologia, Ospedale Santa Maria della Misericordia, Perugia, Italy., Alfonso Marrelli, Oriano Mecarelli, Chiara Minardi, Fabio Minicucci, Lucia Politini, Eugenio Vitelli, Adriano Peris, Aldo Amantini, Antonello Grippo, Claudio Sandroni, and ProNeCA Study Group.
• IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy.
• Resuscitation. 2022 Dec 1; 181: 133139133-139.

AimTo assess if the amplitude of the N20 wave (N20Amp) of somatosensory evoked potentials (SSEPs) changes between 12-24 h and 72 h from the return of spontaneous circulation (ROSC) after cardiac arrest and if an N20Amp decrease predicts poor neurological outcome (CPC 3-5) at six months.SettingRetrospective analysis of the ProNeCA multicentre prognostication study dataset. (NCT03849911).MethodsIn adult comatose cardiac arrest survivors whose SSEPs were recorded at both 12-24 h and 72 h after ROSC, we measured the median N20Amp at each timepoint and the individual change in N20Amp across the two timepoints. We identified their cutoffs for predicting poor outcome with 0% false positive rate (FPR) and compared their sensitivities.ResultsWe included 236 patients. The median [IQR] N20Amp increased from 1.90 [0.78-4.22] µV to 2.86 [1.52-5.10] µV between 12-24 h and 72 h (p = 0.0019). The N20Amp cutoff for 0% FPR increased from 0.6 µV at 12-24 h to 1.23 µV at 72 h, and its sensitivity increased from 56[48-64]% to 71[63-77]%. Between 12-24 h and 72 h, an N20Amp decrease > 53% predicted poor outcome with 0[0-5]% FPR and 26[19-35]% sensitivity. Its combination with an N20Amp < 1.23 µV at 72 h increased sensitivity by 1% to 72[64-79]%.ConclusionIn comatose cardiac arrest survivors, the median N20Amp and its cutoff for predicting poor neurological outcome increase between 12-24 and 72 h after ROSC. An N20Amp decrease greater than 53% between these two timepoints predicts poor outcome with 0% FPR, confirming the unfavourable prognostic signal of a low N20Amp at 72 h.Copyright © 2022 Elsevier B.V. All rights reserved.

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