Early detection of brain death using the Bispectral Index (BIS) in patients treated by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest

Romain Jouffroy; Lionel Lamhaut; Alexandra Guyard; Pascal Philippe; Kim An; Christian Spaulding; Frédéric Baud; Pierre Carli; Benoît Vivien

doi:10.1016/j.resuscitation.2017.08.217

Early detection of brain death using the Bispectral Index (BIS) in patients treated by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest

Resuscitation. 2017 Nov:120:8-13. doi: 10.1016/j.resuscitation.2017.08.217. Epub 2017 Aug 24.

Authors

Romain Jouffroy¹, Lionel Lamhaut², Alexandra Guyard¹, Pascal Philippe¹, Kim An¹, Christian Spaulding³, Frédéric Baud⁴, Pierre Carli², Benoît Vivien⁵

Affiliations

¹ Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
² 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.
³ Cardiology Department, Hôpital Européen Georges Pompidou, 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.
⁴ Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France; UMR-8257, Cognition and Action Group (COGNAC G), Paris Descartes University, Paris, France.
⁵ Intensive Care Unit, Anesthesiology Department and SAMU of Paris, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France. Electronic address: benoit.vivien@aphp.fr.

PMID: 28844933
DOI: 10.1016/j.resuscitation.2017.08.217

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Bispectral Index; Brain death; Extracorporeal life support; Mild therapeutic hypothermia; Refractory cardiac arrest; Resuscitation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Brain Death / diagnosis*
Cardiopulmonary Resuscitation / methods*
Consciousness Monitors*
Electroencephalography
Extracorporeal Membrane Oxygenation / mortality*
Female
Humans
Hypothermia, Induced / methods
Intensive Care Units
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / mortality*
Out-of-Hospital Cardiac Arrest / therapy
Point-of-Care Systems
Time Factors
Tomography, X-Ray Computed