Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France; Sudden Death Expert Center, Inserm UMR-S970, Paris Cardiovascular Research Centre, Paris Descartes University, Paris, France.
Resuscitation. 2017 Nov;120:8-13. doi: 10.1016/j.resuscitation.2017.08.217. Epub 2017 Aug 24.
Despite increasing use of extracorporeal cardiopulmonary resuscitation (E-CPR) for treatment of refractory cardiac arrest patients, prognosis remains dismal, often resulting in brain-death. However, clinical assessment of brain-death occurence is difficult in post-cardiac arrest patients, sedated, paralyzed, under mild therapeutic hypothermia (MTH). Our objective was to assess the usefulness of Bispectral-Index (BIS) monitoring at bedside for an early detection of brain-death occurrence in refractory cardiac arrest patients treated by E-CPR.
This prospective study was performed in an intensive care unit of an university hospital. Forty-six patients suffering from refractory cardiac arrest treated by E-CPR were included. BIS was continuously recorded during ICU hospitalization. Clinical brain-death was confirmed when appropriate by EEG and/or cerebral CT angiography.
Twenty-nine patients evolved into brain-death and had average BIS values under MTH and after rewarming (temperature ≥35°C) of 4 (0-47) and 0 (0-82), respectively. Among these, 11 (38%) entered into a procedure of organs donation. Among the 17 non-brain-dead patients, the average BIS values at admission and after rewarming were 39 (0-65) and 59 (22-82), respectively. Two patients had on admission a BIS value equal to zero and evolved to a poor prognostic (CPC 4) and died after care limitations. BIS values were significantly different between patients who developed brain death and those who did not. In both groups, no differences were observed between the AUCs of ROC curves for BIS values under MTH and after rewarming (respectively 0.86 vs 0.83, NS).
Initial values of BIS could be used as an assessment tool for early detection of brain-death in refractory cardiac arrest patients treated by mild therapeutic hypothermia and E-CPR.
尽管体外心肺复苏（E-CPR）在治疗难治性心搏骤停患者中的应用越来越多，但预后仍然很差，经常导致脑死亡。然而，在心脏骤停后、镇静、麻痹、轻度治疗性低体温（MTH）下的患者中，临床评估脑死亡的发生具有挑战性。我们的目的是评估床边双频谱指数（BIS）监测在 E-CPR 治疗难治性心搏骤停患者中早期检测脑死亡发生的有用性。
这项前瞻性研究在一家大学医院的重症监护病房进行。纳入 46 例接受 E-CPR 治疗的难治性心搏骤停患者。在 ICU 住院期间连续记录 BIS。通过 EEG 和/或脑 CT 血管造影，在适当的情况下确认临床脑死亡。
29 例患者发展为脑死亡，在 MTH 和复温后（体温≥35°C）的平均 BIS 值分别为 4（0-47）和 0（0-82）。其中 11 例（38%）进入器官捐献程序。在 17 例非脑死亡患者中，入院和复温后的平均 BIS 值分别为 39（0-65）和 59（22-82）。两名患者入院时 BIS 值为零，预后较差（CPC 4），并在限制治疗后死亡。发生脑死亡和未发生脑死亡的患者的 BIS 值存在显著差异。在两组中，MTH 下和复温后 BIS 值的 ROC 曲线的 AUC 之间没有差异（分别为 0.86 与 0.83，NS）。
轻度治疗性低体温和 E-CPR 治疗难治性心搏骤停患者中，BIS 的初始值可用作早期检测脑死亡的评估工具。
