title: Bispectral index to predict neurological outcome early after cardiac arrest.
abstract: OBJECTIVE
  To address the value of continuous monitoring of bispectral index (BIS) to predict neurological outcome after cardiac arrest.
  
  
  METHODS
  In this prospective observational study in adult comatose patients treated by therapeutic hypothermia after cardiac arrest we measured bispectral index (BIS) during the first 24 hours of intensive care unit stay. A blinded neurological outcome assessment by cerebral performance category (CPC) was done 6 months after cardiac arrest.
  
  
  RESULTS
  Forty-six patients (48%) had a good neurological outcome at 6-month, as defined by a cerebral performance category (CPC) 1-2, and 50 patients (52%) had a poor neurological outcome (CPC 3-5). Over the 24h of monitoring, mean BIS values over time were higher in the good outcome group (38 ± 9) compared to the poor outcome group (17 ± 12) (p<0.001). Analysis of BIS recorded every 30 minutes provided an optimal prediction after 12.5h, with an area under the receiver operating characteristic curve (AUC) of 0.89, a specificity of 89% and a sensitivity of 86% using a cut-off value of 23. With a specificity fixed at 100% (sensitivity 26%) the cut-off BIS value was 2.4 over the first 271 minutes. In multivariable analyses including clinical characteristics, mean BIS value over the first 12.5h was a predictor of neurological outcome (p = 6E-6) and provided a continuous net reclassification index of 1.28% (p = 4E-10) and an integrated discrimination improvement of 0.31 (p=1E-10).
  
  
  CONCLUSIONS
  Mean BIS value calculated over the first 12.5h after ICU admission potentially predicts 6-months neurological outcome after cardiac arrest.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Centre Hospitalier de Luxembourg, 4, rue Barblé, L-1210 Luxembourg, Luxembourg. Electronic address: stammet.pascal@chl.lu.
authors.forename: Pascal
authors.initials: P
authors.lastname: Stammet
authors.affiliation: Competence Centre for Methodology and Statistics, Centre de Recherche Public de la Santé (CRP-Santé), 1A-B, rue Thomas Edison, L-1445 Strassen, Luxembourg.
authors.forename: Olivier
authors.initials: O
authors.lastname: Collignon
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Centre Hospitalier de Luxembourg, 4, rue Barblé, L-1210 Luxembourg, Luxembourg.
authors.forename: Christophe
authors.initials: C
authors.lastname: Werer
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Centre Hospitalier de Luxembourg, 4, rue Barblé, L-1210 Luxembourg, Luxembourg.
authors.forename: Claude
authors.initials: C
authors.lastname: Sertznig
authors.affiliation: Laboratory of Cardiovascular Research, Centre de Recherche Public de la Santé (CRP-Santé), 84, Val Fleuri, L-1526 Luxembourg, Luxembourg.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Devaux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000150:complications / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008189:Luxembourg / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012151:Resuscitation; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brain injury; Cardiac arrest; Electroencephalogram; Prediction models.; Prognosis