• Sung Wook Kim, Joo Suk Oh, Jungtaek Park, Hyun Ho Jeong, Ji Hoon Kim, Jung Hee Wee, Sang Hoon Oh, Seung Pill Choi, Kyu Nam Park, and Cerebral Resuscitation and Outcome evaluation Within catholic Network (CROWN) Investigators.
• All authors: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
• Crit. Care Med. 2018 Jun 1; 46 (6): e545-e551.

ObjectivesThe absence of N20 somatosensory evoked potential after cardiac arrest is related to poor outcome. However, discrimination between the low-amplitude and the absence of N20 is challenging. P25 and P30 are short-latency positive peaks with latencies between 25 and 30 ms following N20 (P25/30). P25/30 is evident even with an ambiguous N20 in patients with good outcome. Therefore, we evaluated the predictive value of P25/30 after cardiac arrest.DesignA retrospective observational study.SettingUniversity-affiliated hospital.SubjectsComatose survivors after out-of-hospital cardiac arrest treated by hypothermic targeted temperature management.InterventionNone.Measurements And Main ResultsThe specificity and the positive predictive value of P25/30 and N20 in predicting poor outcome were the same, showing a rate of 100%. The sensitivity of P25/30 in predicting poor outcome (90.12% [95% CI, 81.5-95.6%]) was higher than that of N20 (70.37% [95% CI, 59.2-80%]). Also, the negative predictive value of P25/30 in predicting poor outcome (81.4% [95% CI, 69.4-89.4%]) was higher than that of N20 (59.3% [95% CI, 51-67.1%]). The P25/30-based adjusted model showed a larger area under the curve (0.98 [95% CI, 0.95-1]) compared with the N20-based adjusted model (0.95 [95% CI, 0.91-0.98]) (p = 0.02).ConclusionsThe absence of P25/30 is related to poor outcome with a higher sensitivity, negative predictive value than the absence of N20.

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