Abstract
BackgroundOutcome prediction is crucial for out-of-hospital cardiac arrest (OHCA) survivors. Several attempts have been made to use the bispectral index (BIS) for this purpose. We aimed to investigate the prognostic power of the BIS during the early stage of targeted temperature management (TTM) after OHCA.MethodsFrom Jan 2014 to Feb 2017, the BIS was determined in OHCA patients as soon as possible after the start of TTM. We injected a neuro-muscular blocking agent and recoded the BIS value and the time when the electromyographic (EMG) factor reached zero. The primary outcome was the cerebral performance category scale (CPC) score at 6 months, and a poor outcome was defined as a CPC score of 3, 4, or 5. The exclusion criteria were age under 18 years, traumatic cardiac arrest, and BIS data with a non-zero EMG factor.ResultsSixty-five patients were included in this study. Good outcomes were observed for 16 patients (24.6%), and poor outcomes were observed for 49 patients (75.4%). The mean time of BIS recording was 2.3 ± 1.0 h after return of spontaneous circulation (ROSC). The mean BIS values of the good outcome and poor outcome groups were 35.6 ± 13.1 and 5.5 ± 9.2, respectively (p < 0.001). The area under the curve was 0.961. Use of a cut-off value of 20.5 to predict a good outcome yielded a sensitivity of 87.5% and specificity of 93.9%. Use of a cut-off value of 10.5 to predict a poor outcome yielded a sensitivity of 87.8% and specificity of 100%.ConclusionWith the help of BIS, physicians could predict that a patient who has BIS value over 20.5 after ROSC could have a big chance to get good neurological outcome in less than three hours.
Highlights
Outcome prediction is crucial for out-of-hospital cardiac arrest (OHCA) survivors
Patients This study was conducted on patients who had been treated with temperature management (TTM) and who were unable to obey commands after return of spontaneous circulation (ROSC) due to out-of-hospital cardiac arrest (OHCA)
During the study period, OHCA occurred in 445 patients, ROSC was achieved in 173 patients, and TTM treatment was performed in 75 patients
Summary
Outcome prediction is crucial for out-of-hospital cardiac arrest (OHCA) survivors. Sudden cardiac arrest leads to high mortality rates and lethal sequelae. To minimize these effects, many efforts have been made to develop an emergent medical service system and improve post-cardiac arrest care. Many efforts have been made to develop an emergent medical service system and improve post-cardiac arrest care Despite these efforts, the survival discharge rate and good neurologic outcome rate are 9.6 and 1.9%, respectively, in South Korea [1]. The percentage of cases in which the In this sense, outcome prediction is one of the crucial components in post-cardiac arrest care.
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