Titre
Prediction of awakening from hypothermic post anoxic coma based on auditory discrimination.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Tzovara, A.
Auteure/Auteur
Rossetti, A.O.
Auteure/Auteur
Juan, E.
Auteure/Auteur
Suys, T.
Auteure/Auteur
Viceic, D.
Auteure/Auteur
Rusca, M.
Auteure/Auteur
Oddo, M.
Auteure/Auteur
De Lucia, M.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1531-8249
Statut éditorial
Publié
Date de publication
2016-05
Volume
79
Première page
748
Dernière page/numéro d’article
757
Peer-reviewed
Oui
Langue
anglais
Résumé
OBJECTIVE: Most of the available clinical tests for prognosis of post-anoxic coma are informative of poor outcome. Previous work has shown that an improvement in auditory discrimination over the first days of coma is predictive of awakening. Here, we aimed at evaluating this test on a large cohort of patients undergoing therapeutic hypothermia and at investigating its added value on existing clinical measures.
METHODS: We recorded electroencephalography responses to auditory stimuli in 94 comatose patients, under hypothermia and after re-warming to normal temperature. Auditory discrimination was semi-automatically quantified by decoding electroencephalography responses to frequently repeated vs. rare sounds. Outcome prediction was based on the change of decoding performance from hypothermia to normothermia.
RESULTS: An increase in auditory discrimination from hypothermia to normothermia was observed for 33 out of 94 patients. Among them, 27 awoke from coma, resulting in a positive predictive value of awakening of 82% (95% confidence interval: 0.65-0.93). Most non-survivors showing an improvement in auditory discrimination had incident status epilepticus. By excluding them, 27 out of 29 patients with improvement in auditory discrimination survived, resulting in a considerable improvement of the predictive value for awakening (93%, with 95% confidence interval: 0.77-0.99). Importantly, this test predicted the awakening of 13 out of 51 patients for which the outcome was uncertain based on current tests.
INTERPRETATION: The progression of auditory discrimination from hypothermia to normothermia has a high predictive value for awakening. This quantitative measure provides an added value to existing clinical tests and encourages the maintenance of life support. This article is protected by copyright. All rights reserved.
METHODS: We recorded electroencephalography responses to auditory stimuli in 94 comatose patients, under hypothermia and after re-warming to normal temperature. Auditory discrimination was semi-automatically quantified by decoding electroencephalography responses to frequently repeated vs. rare sounds. Outcome prediction was based on the change of decoding performance from hypothermia to normothermia.
RESULTS: An increase in auditory discrimination from hypothermia to normothermia was observed for 33 out of 94 patients. Among them, 27 awoke from coma, resulting in a positive predictive value of awakening of 82% (95% confidence interval: 0.65-0.93). Most non-survivors showing an improvement in auditory discrimination had incident status epilepticus. By excluding them, 27 out of 29 patients with improvement in auditory discrimination survived, resulting in a considerable improvement of the predictive value for awakening (93%, with 95% confidence interval: 0.77-0.99). Importantly, this test predicted the awakening of 13 out of 51 patients for which the outcome was uncertain based on current tests.
INTERPRETATION: The progression of auditory discrimination from hypothermia to normothermia has a high predictive value for awakening. This quantitative measure provides an added value to existing clinical tests and encourages the maintenance of life support. This article is protected by copyright. All rights reserved.
PID Serval
serval:BIB_D4173B05D4AC
PMID
Open Access
Oui
Date de création
2016-05-17T09:10:42.241Z
Date de création dans IRIS
2025-05-21T03:05:09Z
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Nom
BIB_D4173B05D4AC.P001.pdf
Version du manuscrit
postprint
Taille
1.48 MB
Format
Adobe PDF
PID Serval
serval:BIB_D4173B05D4AC.P001
URN
urn:nbn:ch:serval-BIB_D4173B05D4AC1
Somme de contrôle
(MD5):f711202dea2cbab4d0b74df1e0478342