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• W2112425535 abstract "Dear Sir,Arch et al.1Arch A.E. Chiappa K. Greer D.M. False positive absent somatosensory evoked potentials in cardiac arrest with therapeutic hypothermia.Resuscitation. 2014; 85: e97-e98Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar recently described the case of a young patient with a good neurological outcome despite the finding of a bilateral absent cortical response on median nerve somatosensory evoked potentials (SSEP) 49 h after a cardiac arrest treated with therapeutic hypothermia (TH). The case is interesting because it questions the reliability of SSEP in predicting poor neurological outcome after the introduction of TH. To increase the reliability of SSEP, the Authors advise to wait at least 72 h before performing the recording. We present a case of false positive SSEP which suggests that this 72 h time-limit may still not be sufficient.A 34-year-old drug-addict male underwent a cardiac arrest after cocaine and heroin overdose. Initial rhythm was asystolia and after resuscitation the patient arrived at our hospital with a Glascow Coma Scale of 4/15 and symmetrical, sluggish reactive pupils. TH was initiated 2 h after cardiac arrest with a target temperature of 33 °C for 24 h. It was not possible to carry out SSEP immediately, due to logistical issues, so they were performed about 84 h after the cardiac arrest disclosing a bilateral absent cortical response (Fig. 1A ). In agreement with the family's will, supportive therapy was not withdrawn and during the following days the patient experienced a progressive recovery of consciousness. A further SSEP examination, performed on the 13th day after cardiac arrest recorded a bilateral cortical response with latency and amplitude within the normal limits (Fig. 1B). The patient was transferred to a rehabilitation facility, where he was discharged a few months later with a normal neurological examination.Our case confirms that the finding of a bilateral absent cortical response should be considered with caution in estimating a poor prognosis in patients treated with TH. Indeed, even though SSEP are considered to be reliable even in patients treated with TH,2Sandroni C. Cavallaro F. Callaway C.W. et al.Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 2. Patients treated with therapeutic hypothermia.Resuscitation. 2013; 84: 1324-1338Abstract Full Text Full Text PDF PubMed Scopus (226) Google Scholar there are some concerns related to reports of false positive cases such as ours. Our case raises even more concern due to the long time-interval between the cardiac arrest and the recording of a false positive result (84 h). We hypothesize that the status of active drug-addiction in our patient may have contributed to the prolonged absence of SSEP cortical responses. Chronic illicit drug abuse is indeed known to provoke dysfunction in brain connectivity3Bora E. Yucel M. Fornito A. et al.White matter microstructure in opiate addiction.Addict Biol. 2012; 17: 141-148Crossref PubMed Scopus (102) Google Scholar, 4Hanlon C.A. Beveridge T.J. Porrino L.J. Recovering from cocaine: insight from clinical and preclinical investigations.Neurosci Biobehav Rev. 2013; 37: 2037-2046Crossref PubMed Scopus (32) Google Scholar and the brain of our patient could have been compromised by years of drug addiction, thus leading to a slower functional recovery after the metabolic storm provoked by cardiac arrest and TH. Moreover, our patient also presented an acute toxic brain injury provoked by the drug overdose which may have contributed to the impairment of normal brain activity.We agree with Arch et al.1Arch A.E. Chiappa K. Greer D.M. False positive absent somatosensory evoked potentials in cardiac arrest with therapeutic hypothermia.Resuscitation. 2014; 85: e97-e98Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar that it is useful to postpone SSEP recording in patients treated with TH, and we suggest to consider carefully a positive result if the patient has health disorders or concomitant neurotoxic conditions which can compromise brain functional recovery, such as chronic drug addiction or acute intoxications.Conflict of interest statementThere are no conflict or competing interests.FundingThis research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Dear Sir, Arch et al.1Arch A.E. Chiappa K. Greer D.M. False positive absent somatosensory evoked potentials in cardiac arrest with therapeutic hypothermia.Resuscitation. 2014; 85: e97-e98Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar recently described the case of a young patient with a good neurological outcome despite the finding of a bilateral absent cortical response on median nerve somatosensory evoked potentials (SSEP) 49 h after a cardiac arrest treated with therapeutic hypothermia (TH). The case is interesting because it questions the reliability of SSEP in predicting poor neurological outcome after the introduction of TH. To increase the reliability of SSEP, the Authors advise to wait at least 72 h before performing the recording. We present a case of false positive SSEP which suggests that this 72 h time-limit may still not be sufficient. A 34-year-old drug-addict male underwent a cardiac arrest after cocaine and heroin overdose. Initial rhythm was asystolia and after resuscitation the patient arrived at our hospital with a Glascow Coma Scale of 4/15 and symmetrical, sluggish reactive pupils. TH was initiated 2 h after cardiac arrest with a target temperature of 33 °C for 24 h. It was not possible to carry out SSEP immediately, due to logistical issues, so they were performed about 84 h after the cardiac arrest disclosing a bilateral absent cortical response (Fig. 1A ). In agreement with the family's will, supportive therapy was not withdrawn and during the following days the patient experienced a progressive recovery of consciousness. A further SSEP examination, performed on the 13th day after cardiac arrest recorded a bilateral cortical response with latency and amplitude within the normal limits (Fig. 1B). The patient was transferred to a rehabilitation facility, where he was discharged a few months later with a normal neurological examination. Our case confirms that the finding of a bilateral absent cortical response should be considered with caution in estimating a poor prognosis in patients treated with TH. Indeed, even though SSEP are considered to be reliable even in patients treated with TH,2Sandroni C. Cavallaro F. Callaway C.W. et al.Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 2. Patients treated with therapeutic hypothermia.Resuscitation. 2013; 84: 1324-1338Abstract Full Text Full Text PDF PubMed Scopus (226) Google Scholar there are some concerns related to reports of false positive cases such as ours. Our case raises even more concern due to the long time-interval between the cardiac arrest and the recording of a false positive result (84 h). We hypothesize that the status of active drug-addiction in our patient may have contributed to the prolonged absence of SSEP cortical responses. Chronic illicit drug abuse is indeed known to provoke dysfunction in brain connectivity3Bora E. Yucel M. Fornito A. et al.White matter microstructure in opiate addiction.Addict Biol. 2012; 17: 141-148Crossref PubMed Scopus (102) Google Scholar, 4Hanlon C.A. Beveridge T.J. Porrino L.J. Recovering from cocaine: insight from clinical and preclinical investigations.Neurosci Biobehav Rev. 2013; 37: 2037-2046Crossref PubMed Scopus (32) Google Scholar and the brain of our patient could have been compromised by years of drug addiction, thus leading to a slower functional recovery after the metabolic storm provoked by cardiac arrest and TH. Moreover, our patient also presented an acute toxic brain injury provoked by the drug overdose which may have contributed to the impairment of normal brain activity. We agree with Arch et al.1Arch A.E. Chiappa K. Greer D.M. False positive absent somatosensory evoked potentials in cardiac arrest with therapeutic hypothermia.Resuscitation. 2014; 85: e97-e98Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar that it is useful to postpone SSEP recording in patients treated with TH, and we suggest to consider carefully a positive result if the patient has health disorders or concomitant neurotoxic conditions which can compromise brain functional recovery, such as chronic drug addiction or acute intoxications. Conflict of interest statementThere are no conflict or competing interests. There are no conflict or competing interests. FundingThis research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors." @default.
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