Department of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
Department of Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium.
Crit Care. 2017 Aug 22;21(1):221. doi: 10.1186/s13054-017-1806-y.
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%.
Between 2011 and 2015, all successfully resuscitated OHCA patients were treated with targeted temperature management (TTM) at 33 °C for 24 hours followed by rewarming over 12 hours (0.3 °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.
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).
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.
对院外心脏骤停（OHCA）幸存者进行预后判断通常较为困难。最近的研究表明，双频谱指数（BIS）监测有助于早期神经预后判断。本研究旨在通过将特异性设定为 100%，探究 BIS 值等于零（BIS 0）（即持续时间和/或单侧与双侧出现）的特征是否比单纯 BIS 0 的出现更能预测 OHCA 后不良神经结局。
2011 年至 2015 年，所有成功复苏的 OHCA 患者均接受目标温度管理（TTM）治疗，在 33°C 下持续 24 小时，然后以 0.3°C/h 的速度复温 12 小时。共有 77 例 OHCA 患者的 BIS 值被记录。计算单侧（一侧半球 BIS 0）和双侧（两侧半球 BIS 0）BIS 0 值的出现以及它们的总持续时间。从 TTM 开始计算 BIS 0 值的总持续时间，绘制 BIS 0 值的接收者操作特征（ROC）曲线，以确定不良神经结局。
77 例 OHCA 患者中，有 30 例（39%）在入院后 48 小时内至少出现一次 BIS 0 值。在这 30 例患者中，6 例（20%）有良好的神经结局（脑功能分类（CPC）1-2），24 例（80%）有不良神经结局（CPC3-5），在 CA 后 180 天。在这 30 例患者中，双侧 BIS 0 值的发生率在神经结局不良的患者中更高（CPC1-2：2（33%）比 CPC3-5：19（79%）；p=0.028）。BIS 0 值的存在预测不良神经结局的敏感性为 62%，特异性为 84%（AUC：0.729；p=0.001）。ROC 分析显示，前 48 小时内计算的 BIS 0 值持续 30.3 分钟预测不良神经结局的敏感性为 63%，特异性为 100%（AUC：0.861；p=0.007）。
与单次观察相比，（双侧）BIS 0 值持续时间较长是 OHCA 后更好的预后预测指标。
