From the Department of Clinical Neurosciences, Neurology Service (Dr Rossetti) and the Department of Intensive Care Medicine (Dr Oddo), Centre Hospitalier Universitaire Vaudois, Lausanne Hospital and Faculty of Biology and Medicine University of Lausanne.
CORRESPONDENCE TO: Mauro Oddo, MD, Department of Critical Care Medicine, University of Lausanne, Rue du Bugnon 46, Lausanne, Switzerland 1011; e-mail: Mauro.firstname.lastname@example.org
FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
FUNDING/SUPPORT: The Swiss National Science Foundation provides support to Dr Rossetti [Grant CR32I3_143780] and Dr Oddo [Grant 320030_138191].
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We thank Dr Grande-Martín and colleagues for their very valuable comment on our recent article1 in CHEST concerning prognostic assessment of postanoxic comatose patients. They rightly point out that multimodality is of paramount importance to approaching coma prognostication in this setting and add information about the role of middle-latency somatosensory-evoked potentials (N35, N70) as a tool to predict favorable outcome. In fact, this technique was described in detail some time ago,2 but its robustness has been put into question in a large Dutch study, which reported that only 28% of patients with N20 and N70 had a good outcome,3 and it is not widely used. A recent retrospective study reappraising this approach correctly points out that additional prospective work must be performed.4
Dr Grande-Martín and colleagues rightly remind us that assessment of the auditory mismatch negativity needs the presence of an N1 potential. Our group, however, has recently described an automated mismatch negativity algorithm based on an auditory oddball paradigm that does not depend on this assumption; by adding information on patients who will awake, this tool seems indeed to significantly increase the performance of outcome prediction in comatose patients after cardiac arrest.5
As with the N70, however, this method is still not widely used and has not been validated independently. Like Dr Grande-Martín and colleagues, we believe there is an urgent need for refined prognosticators of good outcome. Only future, large-scale studies will allow the generalized implementation of these methods in the prognostication algorithm.
Role of sponsors: The sponsors had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.
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