title: Feasibility of bispectral index monitoring to guide early post-resuscitation cardiac arrest triage.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Maine Medical Center, Department of Critical Care Services, Portland, ME, United States; Maine Medical Center, Neuroscience Institute, Portland, ME, United States. Electronic address: sederd@mmc.org.
authors.forename: David B
authors.initials: DB
authors.lastname: Seder
authors.affiliation: Maine Medical Center, Department of Critical Care Services, Portland, ME, United States.
authors.forename: John
authors.initials: J
authors.lastname: Dziodzio
authors.affiliation: Maine Medical Center, Department of Critical Care Services, Portland, ME, United States.
authors.forename: Kahsi A
authors.initials: KA
authors.lastname: Smith
authors.affiliation: Furman University, Greenville, SC, United States.
authors.forename: Paige
authors.initials: P
authors.lastname: Hickey
authors.affiliation: University of New England, Biddeford, ME, United States.
authors.forename: Brittany
authors.initials: B
authors.lastname: Bolduc
authors.affiliation: University of New England, Biddeford, ME, United States.
authors.forename: Philip
authors.initials: P
authors.lastname: Stone
authors.affiliation: Maine Medical Center, Department of Critical Care Services, Portland, ME, United States.
authors.forename: Teresa
authors.initials: T
authors.lastname: May
authors.affiliation: Maine Medical Center, Department of Critical Care Services, Portland, ME, United States.
authors.forename: Barbara
authors.initials: B
authors.lastname: McCrum
authors.affiliation: Maine Medical Center, Department of Critical Care Services, Portland, ME, United States.
authors.forename: Gilles L
authors.initials: GL
authors.lastname: Fraser
authors.affiliation: Maine Medical Center, Department of Critical Care Services, Portland, ME, United States; Maine Medical Center, Neuroscience Institute, Portland, ME, United States.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Riker
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D013997:Time Factors; D014218:Triage
keywords: Arrest; BIS; Bispectral index; CPR; EEG; Hypothermia