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Beyond induced sedation: BIS for post-arrest monitoring

      Among comatose patients resuscitated from cardiac arrest, non-convulsive seizures and other electroencephalographic (EEG) patterns on the ictal-interictal spectrum are common [
      • Rittenberger J.C.
      • Popescu A.
      • Brenner R.P.
      • Guyette F.X.
      • Callaway C.W.
      Frequency and timing of nonconvulsive status epilepticus in comatose post-cardiac arrest subjects treated with hypothermia.
      ]. Seizures may result in secondary brain injury [
      • Elmer J.
      • Callaway C.W.
      The brain after cardiac arrest.
      ]. Moreover, although studies have not been performed specifically in the post-arrest population, time to antiepileptic drug therapy is generally considered an important predictor of whether seizures are ultimately controlled [
      • Claassen J.
      • Goldstein J.N.
      Emergency neurological life support: status epilepticus.
      ]. Early detection of status epilepticus or other potentially injurious EEG patterns may facilitate the delivery of time-sensitive treatments and improve recovery. In parallel, many abnormal EEG patterns have prognostic significance and strongly predict outcome after cardiac arrest [
      • Oh S.H.
      • Park K.N.
      • Kim Y.M.
      • et al.
      The prognostic value of continuous amplitude-integrated electronencephalogram applied immediately after return of spontaneous circulation in therapeutic hypothermia-treated cardiac arrest pateints.
      ,
      • Elmer J.
      • Gianakas J.J.
      • Rittenberger J.C.
      • et al.
      Group-based trajectory modeling of suppression ratio after cardiac arrest.
      ]. Thus, early detection of these findings might also inform patient triage and early goals of care discussions with surrogates.
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