Abstract
The diagnostic performance of the bispectral index (BIS) to early predict neurological outcomes in patients achieving return of spontaneous circulation (ROSC) after cardiac arrest (CA) remained unclear. We searched PubMed, EMBASE, Scopus and CENTRAL for relevant studies through October 2019. Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Meta-analysis was performed using a linear mixed-effects model to the log-transformed data with a logistic distribution assumption. Bivariate meta-regression was performed to explore heterogeneity. In total, 13 studies with 999 CA adult patients were included. At the optimal threshold of 32, BIS obtained within 72 h of ROSC elicits a pooled sensitivity of 84.9% (95% confidence interval (CI), 71.1% to 92.7%), a pooled specificity of 85.9% (95% CI, 71.2% to 93.8%) and an area under the curve of 0.92. Moreover, a BIS cutoff < 12 yielded a pooled specificity of 95.0% (95% CI, 77.8% to 99.0%). In bivariate meta-regression, the timing of neurological outcome assessment, the adoption of targeted temperature management, and the administration of sedative agents or neuromuscular blocking agents (NMBA) were not identified as the potential source of heterogeneity. BIS retains good diagnostic performance during targeted temperature management (TTM) and in the presence of administrated sedative agents and NMBA. In conclusion, BIS can predict poor neurological outcomes early in patients with ROSC after CA with good diagnostic performance and should be incorporated into the neuroprognostication strategy algorithm.
Highlights
Sudden cardiac arrest (CA) is a challenge in emergency departments
All studies identified from electronic databases were screened and selected by two authors (Y.-J.C. and C.-Y.C.) independently, as per the following inclusion criteria: (a) studies of all design investigating the application of bispectral index (BIS) obtained within 72 h of return of spontaneous circulation (ROSC) to predict neurological outcomes except for letters, case reports, editorials or reviews; (b) adult populations with cardiac arrest presenting to the emergency department or inpatient settings; (c) limited to human studies and no language or ethnicity restrictions were applied
After removing 257 duplicates, the remaining studies were screened for eligibility
Summary
Sudden cardiac arrest (CA) is a challenge in emergency departments. Despite emergency medical services (EMS) and team-based cardiopulmonary resuscitation interventions, the mortality rates remain high. The survival discharge rate in out-of-hospital cardiac arrest (OHCA) patients has not exceed 5% in most communities [1,2]. After CA, 11–12% of them remain in a persistent coma status and up to 18% have moderate to severe functional impairment at hospital discharge [3,4,5,6]. In post-cardiac arrest syndrome, the ischemic reperfusion injury and post-anoxic brain injury are two major causes of mortality in severe neurological. Current guidelines recommend neuroprognostication in patients who remain comatose and unresponsive to pain stimulus after 72 h of ROSC [9]. Several clinical examinations or tools have been suggested to aid in neuroprognostication, such as bilateral absence of pupillary and corneal reflexes, bilateral absence of N20 short-latency somatosensory evoked potentials wave, and a set of specific features on electroencephalography (EEG), brain imaging, etc
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