Evaluation of the Termination of Cardiopulmonary Resuscitation of Cardiopulmonary Arrest Patients in the Emergency Department with a Bispectral Module Device
DOI:
https://doi.org/10.58600/eurjther2864Keywords:
arrest, bispectral index, cardiopulmonary resuscitationAbstract
Objective: The determination to end cardiopulmonary resuscitation (CPR) rests upon the administering physician, who considers a multitude of factors, including witnessed or unwitnessed arrest, duration of CPR, initial arrest rhythm, duration of defibrillation, comorbidities, pre-arrest status, and whether or not spontaneous circulation (ROSC) was achieved during resuscitation.
Methods: This was a single-center, prospective and observational study. The research included patients who experienced in-hospital (IHCA) and out-of-hospital cardiopulmonary arrest (OHCA). The Bispectral index (BIS) value, which is a scored assessment between 0 and 100, was recorded at 10-minute intervals from the start of CPR. The BIS value at the time of death or ROSC was recorded and the procedure was terminated
Results: A total of 25 patients were included and ROSC was achieved in 9 (36%). The mean age of the patients was 64.6 years and 50% had comorbid diseases. Most patients (64%) were brought to the emergency department by an Emergency Medical Technician (EMT). The initial BIS value at the time of initiation of CPR was 35.19 ±14.49 vs 30.44 ±13.13 in patients who died and those who received ROSC, respectively; the BIS value at the time of death decision and ROSC was 34.06 vs 36.56
Conclusion: This study concluded that BIS monitoring is not be sufficient in determining the prognosis of patients with cardiac arrest and guiding decision on terminate of resuscitation.
References
[1] Winship C, Williams B, Boyle MJ (2012) Cardiopulmonary resuscitation before defibrillation in the out-of-hospital setting: a literature review: Table 1. Emerg Med J. 29:826–829. https://doi.org/10.1136/emermed-2011-200080
[2] Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, et al.; Adult Basic and Advanced Life Support Writing Group. (2020) Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 142(16_suppl_2):S366-S468. https://doi.org/10.1161/cir.0000000000000899
[3] Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, et al. (2008) Anesthesia awareness and the bispectral index. N Engl J Med. 358(11):1097-108. https://doi.org/10.1056/nejmoa0707361
[4] Eveson L, Vizcaychipi M, Patil S (2017) Role of bispectral index monitoring and burst suppression in prognostication following out-of-hospital cardiac arrest: a systematic review protocol. Syst Rev. 6(1):191. https://doi.org/10.1186/s13643-017-0584-6
[5] Szekely B, Saint-Marc T, Degrémont AC, Castelain MH, Fischler M (2002) Value of bispectral index monitoring during cardiopulmonary resuscitation. Br J Anaesth. 88(3):443-444. https://doi.org/10.1093/bja/88.3.443
[6] Pawlik MT, Seyfried TF, Riegger C, Klingler W, Selig C (2008) Bispectral index monitoring during cardiopulmonary resuscitation repeated twice within 8 days in the same patient: a case report. Int J Emerg Med. 1(3):209-212. https://doi.org/10.1007/s12245-008-0037-z
[7] Goodman PG, Mehta AR, Castresana MR (2009) Predicting ischemic brain injury after intraoperative cardiac arrest during cardiac surgery using the BIS monitor. J Clin Anesth. 21(8):609-12. https://doi.org/10.1016/j.jclinane.2009.01.014
[8] Dumans-Nizard V, Hamada S, Fischler M (2010) Bispectral index during cardiopulmonary resuscitation: a poor indicator of recovery. Two very different cases. Anaesthesia. 65(2):196-198. https://doi.org/10.1111/j.1365-2044.2009.06163.x
[9] Jung JY, Kim Y, Kim JE. (2013) Usefulness of the bispectral index during cardiopulmonary resuscitation -A case report-. Korean J Anesthesiol. 64(1):69-72. https://doi.org/10.4097/kjae.2013.64.1.69
[10] Aprea F, Martin-Jurado O, Jenni S, Mosing M (2014) Bispectral index analysis during cardiac arrest and cardiopulmonary resuscitation in a propofol-anesthetized calf. J Vet Emerg Crit Care (San Antonio). 24(2):221-225. https://doi.org/10.1111/vec.12123
[11] Magid DJ, Aziz K, Cheng A, Hazinski MF, Hoover AV, et al. (2020) Part 2: Evidence Evaluation and Guidelines Development: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 142(16_suppl_2):S358-S365. https://doi.org/10.1161/cir.0000000000000898
[12] Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, et al. (2010) Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 122(18 Suppl 3):S640-656. https://doi.org/10.1161/circulationaha.110.970889
[13] Morrison LJ, Visentin LM, Kiss A, Theriault R, Eby D, et al; TOR Investigators (2006) Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 355(5):478-487. https://doi.org/10.1056/nejmoa052620
[14] Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, et al. (2015) Utstein Collaborators. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A Statement for Healthcare Professionals From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation. 96:328-340. https://doi.org/10.1161/cir.0000000000000710
[15] Blanchard IE, Doig CJ, Hagel BE, Anton AR, Zygun DA, et al. (2012) Emergency medical services response time and mortality in an urban setting. Prehosp Emerg Care. 16(1):142-151. https://doi.org/10.3109/10903127.2011.614046
[16] Sigl JC, Chamoun NG. (1994) An introduction to bispectral analysis for the electroencephalogram. J Clin Monit. 10(6):392-404. https://doi.org/10.1007/bf01618421
[17] Rampil IJ (1998) A primer for EEG signal processing in anesthesia. Anesthesiology. 89(4):980-1002. https://doi.org/10.1097/00000542-199810000-00023
[18] Johansen JW, Sebel PS (2000) Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology.93(5):1336-1344. https://doi.org/10.1097/00000542-200011000-00029
[19] Myles PS, Leslie K, McNeil J, Forbes A, Chan MT (2004) Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 363(9423):1757-1763. https://doi.org/10.1016/s0140-6736(04)16300-9
[20] Aspect Medical Systems (2005) BIS VISTA monitoring system operator’s manual. Available from: http://www.telemedrs.com/pdf/uputstva/bis_vista_manual.pdf . Accessed September 1, 2021.
[21] Morrison LJ, Verbeek PR, Vermeulen MJ, Kiss A, Allan KS, et al (2007) Derivation and evaluation of a termination of resuscitation clinical prediction rule for advanced life support providers. Resuscitation. 74(2):266-275. https://doi.org/10.1016/j.resuscitation.2007.01.009
[22] Jordan MR, O’Keefe MF, Weiss D, et al (2017) Implementation of the universal BLS termination of resuscitation rule in a rural EMS system. Resuscitation. 118:75–81. https://doi.org/10.1016/j.resuscitation.2017.07.004
[23] Chollet-Xémard C, Combes X, Soupizet F, et al (2009) Bispectral index monitoring is useless during cardiac arrest patients’ resuscitation. Resuscitation. 80:213–216. https://doi.org/10.1016/j.resuscitation.2008.10.011
[24] Petrie DA, De Maio V, Stiell IG, et al (2001) Factors affecting survival after prehospital asystolic cardiac arrest in a Basic Life Support-Defibrillation system. CJEM. 3:186–192. https://doi.org/10.1017/S1481803500005522
[25] Friberg H, Westhall E, Rosén I, Rundgren M, Nielsen N, Cronberg T (2013) Clinical review: Continuous and simplified electroencephalography to monitor brain recovery after cardiac arrest. Crit Care. 17(4):233. https://doi.org/10.1186/cc12699
[26] Sandroni C, Cariou A, Cavallaro F, Cronberg T, Friberg H, et al. (2014) Prognostication in comatose survivors of cardiac arrest: an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine. Resuscitation. 85(12):1779-1789. https://doi.org/10.1016/j.resuscitation.2014.08.011
[27] Selig C, Riegger C, Dirks B, et al (2014) Bispectral index (BIS) and suppression ratio (SR) as an early predictor of unfavourable neurological outcome after cardiac arrest. Resuscitation 85:221–226. https://doi.org/10.1016/j.resuscitation.2013.11.008
Downloads
Published
How to Cite
License
Copyright (c) 2025 Adnan Hocaoğlu, Muhammet Esat Karaduman, Mustafa Sabak, Şevki Hakan Eren
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
