Bispectral index to predict neurological outcome early after cardiac arrest.

Adult; Aged; Aged, 80 and over; Brain Ischemia/diagnosis/epidemiology/etiology; Electroencephalography; Female; Follow-Up Studies; Heart Arrest/complications/therapy; Humans; Incidence; Intensive Care Units; Luxembourg/epidemiology; Male; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; ROC Curve; Resuscitation; Severity of Illness Index; Survival Rate/trends; Time Factors; Treatment Outcome; Young Adult; Brain injury; Cardiac arrest; Electroencephalogram; Prediction models.

Abstract :

[en] AIM OF THE STUDY: To address the value of continuous monitoring of bispectral index (BIS) to predict neurological outcome after cardiac arrest. METHODS: In this prospective observational study in adult comatose patients treated by therapeutic hypothermia after cardiac arrest we measured bispectral index (BIS) during the first 24 hours of intensive care unit stay. A blinded neurological outcome assessment by cerebral performance category (CPC) was done 6 months after cardiac arrest. RESULTS: Forty-six patients (48%) had a good neurological outcome at 6-month, as defined by a cerebral performance category (CPC) 1-2, and 50 patients (52%) had a poor neurological outcome (CPC 3-5). Over the 24h of monitoring, mean BIS values over time were higher in the good outcome group (38 +/- 9) compared to the poor outcome group (17 +/- 12) (p<0.001). Analysis of BIS recorded every 30 minutes provided an optimal prediction after 12.5h, with an area under the receiver operating characteristic curve (AUC) of 0.89, a specificity of 89% and a sensitivity of 86% using a cut-off value of 23. With a specificity fixed at 100% (sensitivity 26%) the cut-off BIS value was 2.4 over the first 271 minutes. In multivariable analyses including clinical characteristics, mean BIS value over the first 12.5h was a predictor of neurological outcome (p = 6E-6) and provided a continuous net reclassification index of 1.28% (p = 4E-10) and an integrated discrimination improvement of 0.31 (p=1E-10). CONCLUSIONS: Mean BIS value calculated over the first 12.5h after ICU admission potentially predicts 6-months neurological outcome after cardiac arrest.

Disciplines :

Anesthesia & intensive care

Author, co-author :

Stammet, Pascal ; Université de Liège - ULiège > Doct. sc. médicales (Bologne)

Collignon, Olivier

Werer, Christophe

Sertznig, Claude

Devaux, Yvan

Language :

English

Title :

Bispectral index to predict neurological outcome early after cardiac arrest.

Publication date :

2014

Journal title :

Resuscitation

ISSN :

0300-9572

eISSN :

1873-1570

Publisher :

Elsevier, Netherlands

Volume :

Issue :

Pages :

1674-80

Peer reviewed :

Peer Reviewed verified by ORBi

Commentary :

Available on ORBi :

since 24 March 2016

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