Comprehensive Summary
Scarpino et al. performed a prospective study at Careggi University Hospital, enrolling 65 comatose adults resuscitated from cardiac arrest to determine whether ultra-early somatosensory evoked potentials (SSEPs) could provide reliable prognostication. Within six hours of the return of spontaneous circulation, patients underwent comprehensive multimodal evaluation, including SSEPs, EEG, brain CT, and serum neuron-specific enolase. The classic finding of bilaterally absent N20 waves retained perfect specificity for poor outcome but only moderate sensitivity. When low-amplitude, prolonged N20 responses lacking the N70 middle-latency component were considered, sensitivity for poor outcome rose to 93% without loss of specificity. Conversely, preserved high-amplitude N20 waves of normal duration accompanied by an intact N70 predicted neurological recovery with 94% sensitivity and 100% specificity. These quantitative refinements rendered SSEPs the most powerful early predictor, surpassing all other indices, and every patient with a poor outcome demonstrated at least two convergent unfavorable markers.
Outcomes and Implications
This investigation underscores the capacity of ultra-early quantitative SSEP analysis to transform neuroprognostication after cardiac arrest. By interrogating both short- and middle-latency cortical responses, clinicians can achieve highly accurate, bidirectional predictions within hours: a dramatic advance over dominant frameworks that defer reliable assessment for days. Such prognostic precision has profound implications: enabling earlier stratification for neuroprotective interventions, curbing premature withdrawal of therapy, guiding resource stewardship, and fostering transparent communication with families. Although confirmation in larger multicenter cohorts is essential, the study positions ultra-early SSEP assessment as a potentially paradigm-shifting tool, redefining the temporal boundaries of prognostication in post-anoxic coma.