Bispectral Index for Prognostication After Cardiac Arrest

Hoedemaekers, Cornelia; Abdo, Wilson F.

doi:10.1097/ccm.0000000000000187

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…Although these studies show promising uses for BIS, which is far easier to implement in the intensive care setting compared to SSEPs, several limitations exist with the usage of BIS. For instance, since BIS only outputs a processed EEG signal, BIS signal interference from confounding factors such as extraneous EMG activity or electrical devices such as pacemakers cannot easily be detected [153]. More studies concomitantly measuring BIS and EEG signals are needed to confirm the accuracy of BIS prediction of poor neurologic outcome.…”

Section: Brain Imagingmentioning

confidence: 99%

Resuscitating the Globally Ischemic Brain: TTM and Beyond

et al. 2020

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Cardiac arrest (CA) afflicts~550,000 people each year in the USA. A small fraction of CA sufferers survive with a majority of these survivors emerging in a comatose state. Many CA survivors suffer devastating global brain injury with some remaining indefinitely in a comatose state. The pathogenesis of global brain injury secondary to CA is complex. Mechanisms of CAinduced brain injury include ischemia, hypoxia, cytotoxicity, inflammation, and ultimately, irreversible neuronal damage. Due to this complexity, it is critical for clinicians to have access as early as possible to quantitative metrics for diagnosing injury severity, accurately predicting outcome, and informing patient care. Current recommendations involve using multiple modalities including clinical exam, electrophysiology, brain imaging, and molecular biomarkers. This multi-faceted approach is designed to improve prognostication to avoid "self-fulfilling" prophecy and early withdrawal of life-sustaining treatments. Incorporation of emerging dynamic monitoring tools such as diffuse optical technologies may provide improved diagnosis and early prognostication to better inform treatment. Currently, targeted temperature management (TTM) is the leading treatment, with the number of patients needed to treat being~6 in order to improve outcome for one patient. Future avenues of treatment, which may potentially be combined with TTM, include pharmacotherapy, perfusion/oxygenation targets, and pre/postconditioning. In this review, we provide a bench to bedside approach to delineate the pathophysiology, prognostication methods, current targeted therapies, and future directions of research surrounding hypoxic-ischemic brain injury (HIBI) secondary to CA.

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Section: Brain Imagingmentioning

confidence: 99%