심정지 후 혼수 환자에서 다중 뇌유발전위 검사의 예후 예측의 유용성 = Predictive Value of Multimodal EvokedPotentials in Comatose Survivors afterCardiac Arrest.

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the prognostic value of multimodal
evoked potentials in predicting both awakening and failure
to awake from coma due to cardiac arrest.
Methods: Multimodal evoked potentials composed of
somatosensory evoked potentials (SEPs), visual evoked
potentials (VEPs) and brainstem auditory evoked potentials
(BAEPs) were recorded for 46 patients with anoxicischemic
encephalopathy who had coma duration>24 h.
Patients with trauma, stroke, malignancy, or age<14 y were
excluded. Outcomes were categorized as awakening (GOS
3-5) vs. vegetative state or death (GOS 1-2).
Results: Forty-one percent of patients regained consciousness,
and 59% died or remained vegetative. Bilaterally
absent SEP N20 peaks predicted non-awakening with a
sensitivity of 52% and a specificity of 100%. Unilaterally or
bilaterally absent BAEP III-V predicted non-awakening with
a sensitivity of 12% and a specificity of 100%. Using bilaterally
absent SEP N20 peaks, unilaterally or bilaterally absent
BAEP III-V, or both of the above predicted non-awakening
with a sensitivity of 56% and a specificity of 100%.
Bilaterally present SEP N20 peaks predicted awakening
with a sensitivity of 100% and a specificity of 63%.
However, the combination of bilateral presence of SEP N20 and VEP P100 in predicting awakening increased the
specificity to 74%, reaching a sensitivity of 89%, a PPV of
71% and a NPV of 91%.
Conclusion: Non-awakening in postanoxic coma can be reliably
predicted with SEPs and BAEPs. Bilaterally preserved
SEPs and VEPs predicted awakening with an accuracy of
80% at 1~4 days after cardiopulmonary resuscitation.

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