Evidence map›Paper›PMID 36123569›Full record

Trial reportNeurocritical care2023

Short-Acting Neuromuscular Blockade Improves Inter-rater Reliability of Median Somatosensory Evoked Potentials in Post-cardiac arrest Prognostication.

Tatsuya Oishi, James D Triplett, Ruple S Laughlin, Sara E Hocker, Sarah E Berini, Ernest M Hoffman

Abstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Neurocritical care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
1.5field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 6 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 1 institution in 2 countries.

Tatsuya OishiDepartment of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA. Oishi.tatsuya@mayo.edu.ORCID http://orcid.org/0000-0003-2817-2579
James D TriplettDepartment of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.ORCID http://orcid.org/0000-0001-9402-1248
Ruple S LaughlinDepartment of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.ORCID http://orcid.org/0000-0002-1884-5824
Sara E HockerDepartment of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.ORCID http://orcid.org/0000-0001-8072-564X
Sarah E BeriniDepartment of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.
Ernest M HoffmanDepartment of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.ORCID http://orcid.org/0000-0001-7293-8290
Mayo Clinic · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough median nerve somatosensory evoked potentials are routinely used for prognostication in comatose cardiac arrest survivors, myogenic artifact can reduce inter-rater reliability, leading to unreliable or inaccurate results. To minimize this risk, we determined the benefit of neuromuscular blockade agents in improving the inter-rater reliability and signal-to-noise ratio of SSEPs in the context of prognostication.

methodsThirty comatose survivors of cardiac arrest were enrolled in the study, following the request from an intensivist to complete an SSEP for prognostication. Right and left median nerve SSEPs were obtained from each patient, before and after administration of an NMB agent. Clinical histories and outcomes were retrospectively reviewed. The SSEP recordings before and after NMB were randomized and reviewed by five blinded raters, who assessed the latency and amplitude of cortical and noncortical potentials (vs. absence of response) as well as the diagnostic quality of cortical recordings. The inter-rater reliability of SSEP interpretation before and after NMB was compared via Fleiss' κ score.

resultsFollowing NMB administration, Fleiss' κ score for cortical SSEP interpretation significantly improved from 0.37 to 0.60, corresponding to greater agreement among raters. The raters were also less likely to report the cortical recordings as nondiagnostic following NMB (40.7% nondiagnostic SSEPs pre-NMB; 17% post-NMB). The SNR significantly improved following NMB, especially when the pre-NMB SNR was low (< 10 dB). Across the raters, there were three patients whose SSEP interpretation changed from bilaterally absent to bilaterally present after NMB was administered (potential false positives without NMB).

conclusionsNMB significantly improves the inter-rater reliability and SNR of median SSEPs for prognostication among comatose cardiac arrest survivors. To ensure the most reliable prognostic information in comatose post-cardiac arrest survivors, pharmacologic paralysis should be consistently used before recording SSEPs.

Indexed as

Heart ArrestNeuromuscular BlockadeComaEvoked Potentials, SomatosensoryHumansPrognosisReproducibility of ResultsRetrospective StudiesCardiac arrestComaNeuromuscular blockadePrognosisSomatosensory evoked potentials

Identifiers

PMID36123569
OpenAlexW4296458986

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.