Bispectral index to predict neurological outcome early after cardiac arrest

Resuscitation. 2014 Dec;85(12):1674-80. doi: 10.1016/j.resuscitation.2014.09.009. Epub 2014 Sep 23.


Aim of the study: 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.

Keywords: Brain injury; Cardiac arrest; Electroencephalogram; Prediction models.; Prognosis.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Ischemia / diagnosis*
  • Brain Ischemia / epidemiology
  • Brain Ischemia / etiology
  • Electroencephalography
  • Female
  • Follow-Up Studies
  • Heart Arrest / complications
  • Heart Arrest / therapy*
  • Humans
  • Incidence
  • Intensive Care Units
  • Luxembourg / epidemiology
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Resuscitation*
  • Severity of Illness Index
  • Survival Rate / trends
  • Time Factors
  • Treatment Outcome
  • Young Adult