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The bispectral index and suppression ratio are very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest

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Abstract

Purpose

To evaluate the bispectral index (BIS) and suppression ratio (SR) as very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest.

Methods

Demographic data, BIS1, and SR1 were recorded from 97 patients after the first dose of neuromuscular blockade, with outcomes blinded, and compared to the discharge Cerebral Performance Category (CPC). Receiver-operator characteristic curves and a multiple logistic regression model were constructed to predict good (CPC 1-2, GO) and poor (CPC 3-5, PO) neurological outcomes.

Results

Fourteen patients were excluded from the final analysis; 33 of the remaining 83 patients (40%) were classified as GO. The BIS1 was higher in patients with GO (37 [28–40] vs. 7 [3–15], p < 0.001). BIS1 < 22 predicted PO with a likelihood ratio (LR) of 14.2 and an area under the curve (AUC) of 0.91 (95% CI 0.85–0.98, p < 0.001). SR1 ≥48 predicted PO with a LR of 12.7 and an AUC of 0.90 (95% CI 0.83–0.98, p < 0.001). Both BIS1 (ΔAUC 0.16, p = 0.006) and SR1 (ΔAUC 0.16, p = 0.005) predicted outcomes better than the time to return of spontaneous circulation.

Conclusions

In our single-center cohort utilizing moderate sedation, the bispectral index and suppression ratio recorded after the first dose of intermittent neuromuscular blockade were accurate and very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest.

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Acknowledgments

We would like to acknowledge Lee Lucas, PhD, and Walter Allen, MD, for their assistance with data analysis and interpretation, Christine Lord, RN, and the Department of Cardiac Services for their advocacy and leadership in our TH program, Aspect Medical Systems for equipment support and expertise, and the Maine Medical Center Neuroscience and Research Institutes for generous financial support.

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Authors and Affiliations

  1. Neuroscience Institute, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA

    David B. Seder, Gilles L. Fraser, Tracy Robbins, Laurel Libby & Richard R. Riker

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  1. David B. Seder
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  2. Gilles L. Fraser
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  3. Tracy Robbins
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Correspondence to David B. Seder.

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Seder, D.B., Fraser, G.L., Robbins, T. et al. The bispectral index and suppression ratio are very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest. Intensive Care Med 36, 281–288 (2010). https://doi.org/10.1007/s00134-009-1691-1

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