Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/25752
Title: Recorded time periods of bispectral index values equal to zero predict neurological outcome after out-of-hospital cardiac arrest
Authors: EERTMANS, Ward 
GENBRUGGE, Cornelia 
Haesevoets, Gilles
DENS, Jo 
BOER, Willem 
JANS, Frank 
DE DEYNE, Cathy 
Issue Date: 2017
Publisher: BIOMED CENTRAL LTD
Source: CRITICAL CARE, 21 (Art N° 221)
Abstract: Background: Prognostication in out-of-hospital cardiac arrest (OHCA) survivors is often difficult. Recent studies have shown the predictive ability of bispectral index (BIS) monitoring to assist with early neuroprognostication. The aim of this study was to investigate whether characteristics of BIS values equal to zero (BIS 0) (i.e. duration and/or uni-versus bilateral presence) instead of simply their occurrence are better indicators for poor neurological outcome after OHCA by aiming at a specificity of 100%. Methods: Between 2011 and 2015, all successfully resuscitated OHCA patients were treated with targeted temperature management (TTM) at 33 degrees C for 24 hours followed by rewarming over 12 hours (0.3 degrees C/h). In total, BIS values were registered in 77 OHCA patients. The occurrence of unilateral (BIS 0 at one hemisphere) and bilateral (BIS 0 at both hemispheres) BIS 0 values as well as their total duration were calculated. Receiver operating characteristic (ROC) curves were constructed using the total duration with BIS 0 values calculated from the initiation of TTM onwards to determine poor neurological outcome. Results: In 30 of 77 OHCA patients (39%), at least one BIS 0 value occurred during the first 48 hours after admission. Of these 30 patients, six (20%) had a good (cerebral performance category (CPC) 1-2) and 24 (80%) a poor neurological outcome (CPC3-5) at 180 days post-CA. Within these 30 patients, the incidence of bilateral BIS 0 values was higher in patients with poor neurological outcome (CPC1-2: 2 (33%) vs. CPC3-5: 19 (79%); p = 0.028). The presence of a BIS 0 value predicted poor neurological outcome with a sensitivity of 62% and specificity of 84% (AUC: 0.729; p = 0.001). With a ROC analysis, a total duration of 30,3 minutes with BIS 0 values calculated over the first 48 hours predicted poor neurological outcome with a sensitivity of 63% and specificity of 100% (AUC: 0.861; p = 0.007). Conclusions: This study shows that a prolonged duration with (bilateral) BIS 0 values serves as a better outcome predictor after OHCA as compared to a single observation.
Notes: [Eertmans, Ward; Genbrugge, Cornelia; Haesevoets, Gilles; Dens, Jo; Jans, Frank; De Deyne, Cathy] Hasselt Univ, Dept Med & Life Sci, Diepenbeek, Belgium. [Eertmans, Ward; Genbrugge, Cornelia; Haesevoets, Gilles; Boer, Willem; Jans, Frank; De Deyne, Cathy] Ziekenhuis Oost Limburg, Dept Anaesthesiol Intens Care Emergency Med & Pai, Genk, Belgium. [Dens, Jo] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium.
Keywords: Cardiac arrest; Prognostication; Neuromonitoring; Targeted temperature management;Cardiac arrest; Prognostication; Neuromonitoring; Targeted temperature management
Document URI: http://hdl.handle.net/1942/25752
ISSN: 1466-609X
e-ISSN: 1364-8535
DOI: 10.1186/s13054-017-1806-y
ISI #: 000415178200001
Rights: © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Category: A1
Type: Journal Contribution
Validations: ecoom 2018
Appears in Collections:Research publications

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