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Resuscitation
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Resuscitation
Article . 2017 . Peer-reviewed
License: Elsevier TDM
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Auditory discrimination improvement predicts awakening of postanoxic comatose patients treated with targeted temperature management at 36 °C

Authors: Pfeiffer, C.; Nguissi, NAN; Chytiris, M.; Bidlingmeyer, P.; Haenggi, M.; Kurmann, R.; Zubler, F.; +3 Authors

Auditory discrimination improvement predicts awakening of postanoxic comatose patients treated with targeted temperature management at 36 °C

Abstract

Outcome prognostication in postanoxic comatose patients is more accurate in predicting poor than good recovery. Using electroencephalography recordings in patients treated with targeted temperature management at 33°C (TTM 33), we have previously shown that improvement in auditory discrimination over the first days of coma predicted awakening. Given the increased application of a 36°C temperature target (TTM 36), here we aimed at validating the predictive value of auditory discrimination in the TTM 36 setting.In this prospective multicenter study, we analyzed the EEG responses to auditory stimuli from 60 consecutive patients from the first and second coma day. A semiautomatic decoding analysis was applied to single patient data to quantify discrimination performance between frequently repeated and deviant sounds. The decoding change from the first to second day was used for predicting patient outcome.We observed an increase in auditory discrimination in 25 out of 60 patients. Among them, 17 awoke from coma (68% positive predictive value; 95% confidence interval: 0.46-0.85). By excluding patients with electroencephalographic epileptiform features, 15 of 18 exhibited improvement in auditory discrimination (83% positive predictive value; 95% confidence interval: 0.59-0.96). Specificity of good outcome prediction increased after adding auditory discrimination to EEG reactivity.These results suggest that tracking of auditory discrimination over time is informative of good recovery independent of the temperature target. This quantitative test provides complementary information to existing clinical tools by identifying patients with high chances of recovery and encouraging the maintenance of life support.

Keywords

Adult, Aged, 80 and over, Male, Electroencephalography, Middle Aged, Prognosis, Acoustic Stimulation/methods; Adult; Aged; Aged, 80 and over; Coma/etiology; Coma/mortality; Coma/physiopathology; Electroencephalography; Evoked Potentials, Auditory; Female; Heart Arrest/complications; Heart Arrest/therapy; Humans; Hypothermia, Induced/methods; Hypoxia-Ischemia, Brain/etiology; Male; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; Cardiac arrest; Coma; EEG; Mismatch negativity; Multivariate decoding; Targeted temperature management, Heart Arrest, Acoustic Stimulation, Hypothermia, Induced, Predictive Value of Tests, Hypoxia-Ischemia, Brain, Evoked Potentials, Auditory, Humans, Female, Prospective Studies, Coma, Aged

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    popularity
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    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
12
Top 10%
Average
Top 10%
Green
bronze