| Title: |
CAN BISPECTRAL INDEX MONITORING HELP IN THE MANAGEMENT OF THE COMATOSE PATIENT AFTER RESUSCITATION FROM CARDIAC ARREST? |
| Authors: |
Caldarella, Y; Menegon, V; Barbisan, D; Sciarretta, T; Prete, G; Possamai, M; Cernetti, C; Gasparetto, N |
| Source: |
European Heart Journal Supplements ; volume 27, issue Supplement_5 ; ISSN 1520-765X 1554-2815 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2025 |
| Description: |
Post–cardiac arrest syndrome is a complex condition increasingly present in our cardiac intensive care units (ICU). Intensive care cardiologists must assess neurological prognosis and address conditions like status epilepticus, which can further deteriorate outcomes. This necessitates a multiparametric approach involving neurological examination, laboratory tests, radiological and neurophysiological studies. Electroencephalogram (EEG) is crucial for detecting epileptiform brain activity. International guidelines recommend performinf EEG after 48 hours from admission, which may delay non convulsive status epilepticus (NCSE) diagnosis. In our unit, we have recently introduced bispectral index (BIS) monitoring for post–cardiac arrest comatose patients. BIS analyzes with a set of electrodes applied on the forehead the EEG signal, displaying a simplified EEG trace, a spectroscopic representation of brain activity, and a sedation depth index. We hypothesize that BIS monitoring can aid in early NCSE detection and treatment in comatose, sedated patients. A 43–year–old male was admitted to our cardiac ICU after an out–of–hospital cardiac arrest. The patient, with a known history of supraventricular extrasystoles, was found gasping by cohabitants. After 15 minutes of ineffective bystander CPR, the advanced rescue team arrived and detected fine–wave ventricular fibrillation. Return of spontaneous circulation was achieved after five resuscitation cycles according to ACLS protocol. Upon admission, the patient was comatose with a Glasgow Coma Scale (GCS) score of 3 but corneal and pupillary reflexes were present. BIS during sedation showed prevalent cerebral activity in the 4 Hz frequency band, indicating deep coma. BIS simplified EEG trace showed pointed abnormalities suggestive of NCSE, which was confirmed by a prompt standard EEG. PESS were also performed, revealing bilateral absence of the N20 complex. BIS monitoring detected persistent epileptiform abnormalities in the following days of hospitalization, with ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1093/eurheartjsupp/suaf076.386 |
| Availability: |
https://doi.org/10.1093/eurheartjsupp/suaf076.386; https://academic.oup.com/eurheartjsupp/article-pdf/27/Supplement_5/suaf076.386/63188445/suaf076.386.pdf |
| Rights: |
https://academic.oup.com/pages/standard-publication-reuse-rights |
| Accession Number: |
edsbas.C21A5CE3 |
| Database: |
BASE |