Maine Medical Center, Department of Critical Care Services, Portland, ME, United States; Maine Medical Center, Neuroscience Institute, Portland, ME, United States.
Maine Medical Center, Department of Critical Care Services, Portland, ME, United States.
Resuscitation. 2014 Aug;85(8):1030-6. doi: 10.1016/j.resuscitation.2014.04.016. Epub 2014 Apr 30.
Triage after resuscitation from cardiac arrest is hindered by reliable early estimation of brain injury. We evaluated the performance of a triage model based on early bispectral index (BIS) findings and cardiac risk classes.
Retrospective evaluation of serial patients resuscitated from cardiac arrest, unable to follow commands, and undergoing hypothermia. Patients were assigned to a cardiac risk group: STEMI, VT/VF shock, VT/VF no shock, or PEA/asystole, and to a neurological dysfunction group, based on the BIS score following first neuromuscular blockade (BISi), and classified as BISi>20, BISi 10-20, or BISi<10. Cause of death was described as neurological or circulatory.
BISi in 171 patients was measured at 267(±177)min after resuscitation and 35(±1.7)°C. BISi<10 suffered 82% neurological-cause and 91% overall mortality, BISi 10-20 35% neurological and 55% overall mortality, and BISi>20 12% neurological and 36% overall mortality. 33 patients presented with STEMI, 15 VT/VF-shock, 41 VT/VF-no shock, and 80 PEA/asystole. Among BISi>20 patients, 75% with STEMI underwent urgent cardiac catheterization (cath) and 94% had good outcome. When BISi>20 with VT/VF and shock, urgent cath was infrequent (33%), and 4 deaths (44%) were uniformly of circulatory etiology. Of 56 VT/VF patients without STEMI, 24 were BISi>20 but did not undergo urgent cath - 5(20.8%) of these had circulatory-etiology death. Circulatory-etiology death also occurred in 26.5% BIS>20 patients with PEA/asystole. When BISi<10, a neurological etiology death dominated independent of cardiac risk group.
Neurocardiac triage based on very early processed EEG (BIS) is feasible, and may identify patients appropriate for individualized post-resuscitation care. This and other triage models warrant further study.
心肺复苏后进行分诊时，由于无法可靠地早期评估脑损伤，因此受到阻碍。我们评估了一种基于早期双频谱指数（BIS）发现和心脏风险类别的分诊模型的性能。
对无法听从指令且正在接受低温治疗的心肺复苏后无法存活的连续患者进行回顾性评估。根据首次神经肌肉阻滞（BISi）后 BIS 评分，患者被分配到心脏风险组：ST 段抬高型心肌梗死（STEMI）、室性心动过速/心室颤动性休克（VT/VF-shock）、VT/VF 无休克（VT/VF-no shock）或心搏骤停/无脉电活动（PEA/asystole），并根据 BISi 分为神经功能障碍组，分类为 BISi>20、BISi 10-20 或 BISi<10。死亡原因描述为神经或循环原因。
171 名患者在复苏后 267(±177)min 测量了 BISi，并处于 35(±1.7)℃。BISi<10 的患者 82%死于神经原因，91%总体死亡率；BISi 10-20 的患者 35%死于神经原因，55%总体死亡率；BISi>20 的患者 12%死于神经原因，36%总体死亡率。33 名患者出现 STEMI，15 名 VT/VF-shock，41 名 VT/VF-no shock，80 名 PEA/asystole。BISi>20 的患者中，75%有 STEMI 接受紧急经皮冠状动脉介入治疗（cath），94%有良好的结果。当 VT/VF 伴有休克且 BISi>20 时，紧急 cath 并不常见（33%），且 4 例死亡（44%）均为循环原因。在 56 名无 STEMI 的 VT/VF 患者中，24 名 BISi>20 但未接受紧急 cath - 其中 5 名（20.8%）因循环原因死亡。循环原因死亡也发生在 26.5% BIS>20 的 PEA/asystole 患者中。当 BISi<10 时，神经原因死亡占主导地位，与心脏风险组无关。
基于早期处理脑电图（BIS）的神经心脏分诊是可行的，并且可能识别出适合个体化复苏后护理的患者。这种和其他分诊模型值得进一步研究。
