Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest

Andrew L. Sherman, D. L. Tirschwell, P. J. Micklesen, W. T. Longstreth, Lawrence R. Robinson

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Objective: To examine the utility of somatosensory evoked potential (SEP) peaks and CSF creatine kinase BB isoenzyme activity (CKBB) in predicting nonawakening from coma due to cardiac arrest. Background: Accurate predictors of neurologic outcome in patients comatose after cardiac arrest are needed to improve medical decision making. Methods: A total of 72 comatose patients had bilateral median SEPs, and of these, 52 had CSF and CKBB. Awakening was defined as following commands or having comprehensible speech. Both short (N1) and long (N3) latency SEP peaks were analyzed. Nonparametric analyses were used. Results: For patients who had both tests, CKBB ≥ 205 U/L predicted nonawakening with a sensitivity of 49% and a specificity of 100%. Bilateral absence of the N1 peak predicted nonawakening with a sensitivity of 53% and a specificity of 100%. Using CKBB ≥ 205 U/L, bilaterally absent SEP N1 peaks, or both predicted nonawakening with a sensitivity of 69% and a specificity of 100%. Using CKBB ≥ 205 U/L, bilaterally absent N1 peaks, bilateral N3 ≥ 176 msec or absent, or some combination predicted nonawakening with a sensitivity of 78% and a specificity of 100%. Conclusion: The combination of an absent N1 peak and elevated CKBB performs better than either alone in predicting nonawakening after cardiac arrest. Prolonged or absent N3 latency may increase sensitivity. These results should be interpreted with caution given the small number of patients and the possibility of a self-fulfilling prophecy.

Original languageEnglish
Pages (from-to)889-894
Number of pages6
JournalNeurology
Volume54
Issue number4
StatePublished - Feb 22 2000
Externally publishedYes

Fingerprint

BB Form Creatine Kinase
Heart Arrest
Isoenzymes
Somatosensory Evoked Potentials
Coma
Nervous System

Keywords

  • Cardiac arrest
  • Coma
  • Creatine kinase
  • CSF
  • Somatosensory potentials

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Sherman, A. L., Tirschwell, D. L., Micklesen, P. J., Longstreth, W. T., & Robinson, L. R. (2000). Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest. Neurology, 54(4), 889-894.

Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest. / Sherman, Andrew L.; Tirschwell, D. L.; Micklesen, P. J.; Longstreth, W. T.; Robinson, Lawrence R.

In: Neurology, Vol. 54, No. 4, 22.02.2000, p. 889-894.

Research output: Contribution to journalArticle

Sherman, AL, Tirschwell, DL, Micklesen, PJ, Longstreth, WT & Robinson, LR 2000, 'Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest', Neurology, vol. 54, no. 4, pp. 889-894.
Sherman AL, Tirschwell DL, Micklesen PJ, Longstreth WT, Robinson LR. Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest. Neurology. 2000 Feb 22;54(4):889-894.
Sherman, Andrew L. ; Tirschwell, D. L. ; Micklesen, P. J. ; Longstreth, W. T. ; Robinson, Lawrence R. / Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest. In: Neurology. 2000 ; Vol. 54, No. 4. pp. 889-894.
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AB - Objective: To examine the utility of somatosensory evoked potential (SEP) peaks and CSF creatine kinase BB isoenzyme activity (CKBB) in predicting nonawakening from coma due to cardiac arrest. Background: Accurate predictors of neurologic outcome in patients comatose after cardiac arrest are needed to improve medical decision making. Methods: A total of 72 comatose patients had bilateral median SEPs, and of these, 52 had CSF and CKBB. Awakening was defined as following commands or having comprehensible speech. Both short (N1) and long (N3) latency SEP peaks were analyzed. Nonparametric analyses were used. Results: For patients who had both tests, CKBB ≥ 205 U/L predicted nonawakening with a sensitivity of 49% and a specificity of 100%. Bilateral absence of the N1 peak predicted nonawakening with a sensitivity of 53% and a specificity of 100%. Using CKBB ≥ 205 U/L, bilaterally absent SEP N1 peaks, or both predicted nonawakening with a sensitivity of 69% and a specificity of 100%. Using CKBB ≥ 205 U/L, bilaterally absent N1 peaks, bilateral N3 ≥ 176 msec or absent, or some combination predicted nonawakening with a sensitivity of 78% and a specificity of 100%. Conclusion: The combination of an absent N1 peak and elevated CKBB performs better than either alone in predicting nonawakening after cardiac arrest. Prolonged or absent N3 latency may increase sensitivity. These results should be interpreted with caution given the small number of patients and the possibility of a self-fulfilling prophecy.

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