Bispectral index to predict neurological outcome early after cardiac arrest

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 24. h 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 12.5. h, 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 12.5. h 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 12.5. h after ICU admission potentially predicts 6-months neurological outcome after cardiac arrest.