Early bispectral index and sedation requirements during therapeutic hypothermia predict neurologic recovery following cardiac arrest

Nicholas E. Burjek, Chad E. Wagner, Ryan D. Hollenbeck, Li Wang, Chang Yu, John A. McPherson, Frederic T. Billings

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objectives: To test the hypothesis that low bispectral index scores and low sedative requirements during therapeutic hypothermia predict poor neurologic outcome. Design: Observational study of a prospectively collected cohort. Setting: Cardiovascular ICU. Patients: One hundred sixty consecutive cardiac arrest patients treated with therapeutic hypothermia. Interventions: None. Measurements and results: Eighty-four of the 141 subjects (60%) who survived hypothermia induction were discharged from the ICU with poor neurologic outcome, defined as a cerebral performance category score of 3, 4, or 5. These subjects had lower bispectral index (p < 0.001) and sedative requirements (p < 0.001) during hypothermia compared with the 57 subjects discharged with good outcome. Early prediction of neurologic recovery was best 7 hours after ICU admission, and median bispectral index scores at that time were 31 points lower in subjects discharged with poor outcome (11 [interquartile range, 4-29] vs 42 [37-49], p < 0.001). Median sedation requirements decreased by 17% (interquartile range, -50 to 0%) 7 hours after ICU admission in subjects with poor outcome but increased by 50% (interquartile range, 0-142%) in subjects with good outcome (p < 0.001). Each 10-point decrease in bispectral index was independently associated with a 59% increase in the odds of poor outcome (95% CI, 32-76%; p < 0.001). The model including bispectral index and sedative requirement correctly reclassified 15% of subjects from good to poor outcome and 1% of subjects from poor to good outcome. The model incorrectly reclassified 1% of subjects from poor to good outcome but did not incorrectly reclassify any from good to poor outcome. Conclusions: Bispectral index scores and sedative requirements early in the course of therapeutic hypothermia improve the identification of patients who will not recover from brain anoxia. The ability to accurately predict nonrecovery after cardiac arrest could facilitate discussions with families, reduce patient suffering, and limit use of ICU resources in futile cases.

Original languageEnglish (US)
Pages (from-to)1204-1212
Number of pages9
JournalCritical care medicine
Volume42
Issue number5
DOIs
StatePublished - Jan 1 2014

Fingerprint

Induced Hypothermia
Heart Arrest
Hypnotics and Sedatives
Nervous System
Hypothermia
Brain Hypoxia
Aptitude
Psychological Stress
Observational Studies

Keywords

  • bispectral index
  • cardiac arrest
  • intensive care unit
  • ischemia reperfusion
  • neurologic function
  • sedation
  • therapeutic hypothermia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Burjek, Nicholas E. ; Wagner, Chad E. ; Hollenbeck, Ryan D. ; Wang, Li ; Yu, Chang ; McPherson, John A. ; Billings, Frederic T. / Early bispectral index and sedation requirements during therapeutic hypothermia predict neurologic recovery following cardiac arrest. In: Critical care medicine. 2014 ; Vol. 42, No. 5. pp. 1204-1212.
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abstract = "Objectives: To test the hypothesis that low bispectral index scores and low sedative requirements during therapeutic hypothermia predict poor neurologic outcome. Design: Observational study of a prospectively collected cohort. Setting: Cardiovascular ICU. Patients: One hundred sixty consecutive cardiac arrest patients treated with therapeutic hypothermia. Interventions: None. Measurements and results: Eighty-four of the 141 subjects (60{\%}) who survived hypothermia induction were discharged from the ICU with poor neurologic outcome, defined as a cerebral performance category score of 3, 4, or 5. These subjects had lower bispectral index (p < 0.001) and sedative requirements (p < 0.001) during hypothermia compared with the 57 subjects discharged with good outcome. Early prediction of neurologic recovery was best 7 hours after ICU admission, and median bispectral index scores at that time were 31 points lower in subjects discharged with poor outcome (11 [interquartile range, 4-29] vs 42 [37-49], p < 0.001). Median sedation requirements decreased by 17{\%} (interquartile range, -50 to 0{\%}) 7 hours after ICU admission in subjects with poor outcome but increased by 50{\%} (interquartile range, 0-142{\%}) in subjects with good outcome (p < 0.001). Each 10-point decrease in bispectral index was independently associated with a 59{\%} increase in the odds of poor outcome (95{\%} CI, 32-76{\%}; p < 0.001). The model including bispectral index and sedative requirement correctly reclassified 15{\%} of subjects from good to poor outcome and 1{\%} of subjects from poor to good outcome. The model incorrectly reclassified 1{\%} of subjects from poor to good outcome but did not incorrectly reclassify any from good to poor outcome. Conclusions: Bispectral index scores and sedative requirements early in the course of therapeutic hypothermia improve the identification of patients who will not recover from brain anoxia. The ability to accurately predict nonrecovery after cardiac arrest could facilitate discussions with families, reduce patient suffering, and limit use of ICU resources in futile cases.",
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Early bispectral index and sedation requirements during therapeutic hypothermia predict neurologic recovery following cardiac arrest. / Burjek, Nicholas E.; Wagner, Chad E.; Hollenbeck, Ryan D.; Wang, Li; Yu, Chang; McPherson, John A.; Billings, Frederic T.

In: Critical care medicine, Vol. 42, No. 5, 01.01.2014, p. 1204-1212.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early bispectral index and sedation requirements during therapeutic hypothermia predict neurologic recovery following cardiac arrest

AU - Burjek, Nicholas E.

AU - Wagner, Chad E.

AU - Hollenbeck, Ryan D.

AU - Wang, Li

AU - Yu, Chang

AU - McPherson, John A.

AU - Billings, Frederic T.

PY - 2014/1/1

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N2 - Objectives: To test the hypothesis that low bispectral index scores and low sedative requirements during therapeutic hypothermia predict poor neurologic outcome. Design: Observational study of a prospectively collected cohort. Setting: Cardiovascular ICU. Patients: One hundred sixty consecutive cardiac arrest patients treated with therapeutic hypothermia. Interventions: None. Measurements and results: Eighty-four of the 141 subjects (60%) who survived hypothermia induction were discharged from the ICU with poor neurologic outcome, defined as a cerebral performance category score of 3, 4, or 5. These subjects had lower bispectral index (p < 0.001) and sedative requirements (p < 0.001) during hypothermia compared with the 57 subjects discharged with good outcome. Early prediction of neurologic recovery was best 7 hours after ICU admission, and median bispectral index scores at that time were 31 points lower in subjects discharged with poor outcome (11 [interquartile range, 4-29] vs 42 [37-49], p < 0.001). Median sedation requirements decreased by 17% (interquartile range, -50 to 0%) 7 hours after ICU admission in subjects with poor outcome but increased by 50% (interquartile range, 0-142%) in subjects with good outcome (p < 0.001). Each 10-point decrease in bispectral index was independently associated with a 59% increase in the odds of poor outcome (95% CI, 32-76%; p < 0.001). The model including bispectral index and sedative requirement correctly reclassified 15% of subjects from good to poor outcome and 1% of subjects from poor to good outcome. The model incorrectly reclassified 1% of subjects from poor to good outcome but did not incorrectly reclassify any from good to poor outcome. Conclusions: Bispectral index scores and sedative requirements early in the course of therapeutic hypothermia improve the identification of patients who will not recover from brain anoxia. The ability to accurately predict nonrecovery after cardiac arrest could facilitate discussions with families, reduce patient suffering, and limit use of ICU resources in futile cases.

AB - Objectives: To test the hypothesis that low bispectral index scores and low sedative requirements during therapeutic hypothermia predict poor neurologic outcome. Design: Observational study of a prospectively collected cohort. Setting: Cardiovascular ICU. Patients: One hundred sixty consecutive cardiac arrest patients treated with therapeutic hypothermia. Interventions: None. Measurements and results: Eighty-four of the 141 subjects (60%) who survived hypothermia induction were discharged from the ICU with poor neurologic outcome, defined as a cerebral performance category score of 3, 4, or 5. These subjects had lower bispectral index (p < 0.001) and sedative requirements (p < 0.001) during hypothermia compared with the 57 subjects discharged with good outcome. Early prediction of neurologic recovery was best 7 hours after ICU admission, and median bispectral index scores at that time were 31 points lower in subjects discharged with poor outcome (11 [interquartile range, 4-29] vs 42 [37-49], p < 0.001). Median sedation requirements decreased by 17% (interquartile range, -50 to 0%) 7 hours after ICU admission in subjects with poor outcome but increased by 50% (interquartile range, 0-142%) in subjects with good outcome (p < 0.001). Each 10-point decrease in bispectral index was independently associated with a 59% increase in the odds of poor outcome (95% CI, 32-76%; p < 0.001). The model including bispectral index and sedative requirement correctly reclassified 15% of subjects from good to poor outcome and 1% of subjects from poor to good outcome. The model incorrectly reclassified 1% of subjects from poor to good outcome but did not incorrectly reclassify any from good to poor outcome. Conclusions: Bispectral index scores and sedative requirements early in the course of therapeutic hypothermia improve the identification of patients who will not recover from brain anoxia. The ability to accurately predict nonrecovery after cardiac arrest could facilitate discussions with families, reduce patient suffering, and limit use of ICU resources in futile cases.

KW - bispectral index

KW - cardiac arrest

KW - intensive care unit

KW - ischemia reperfusion

KW - neurologic function

KW - sedation

KW - therapeutic hypothermia

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