Abstract
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 24 h 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 12.5 h, 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 12.5 h 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 12.5 h after ICU admission potentially predicts 6-months neurological outcome after cardiac
arrest.
Keywords
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Article info
Publication history
Published online: September 24, 2014
Accepted:
September 10,
2014
Received in revised form:
September 2,
2014
Received:
July 8,
2014
Footnotes
☆A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.09.009.
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
