Bispectral Index monitoring as an early neurological prognostic tool after an out-of-hospital cardiac arrest successfully resuscitated: a prospective cohort study
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Introduction: out-of-hospital cardiac arrests are one of the major complications of cardiovascular
diseases. Patients who survive a cardiac arrest suffer what is known as Post-Cardiac Arrest
Syndrome, which worst consequence is the post-anoxic encephalopathy, the leading cause of
disability in patients after cardiac arrest. Therapeutic hypothermia, among other interventions, has
proven to diminish the damage to the brain when the patient is in this situation. But, in order to
avoid the painful sensation this treatment causes, patients are sedated. This makes the
neurological evaluation of the patients unreliable with the tools we have until now. So, we have to
wait more than 72 hours to have an accurate prognostic of the patient. In such situation, where
therapeutic decisions on highly invasive acute cardiac assistance have to be taken, the actual
lapse of time is unacceptable.
In the last years, researchers have been looking for new tools that make possible to give an earlier
and accurate prognosis among patients who have suffered cardiac arrests successfully
resuscitated undergoing therapeutic hypothermia. Bispectral index monitoring has been proposed
as a proper tool to assess the neurological prognostic since it could provide us information about
the cerebral perfusion probably earlier than the available tools.
Objective: the aim of this study is to describe patterns among the graphs created with Bispectral
Index values of each patient and to identify if these patterns have a prognostic value in terms of
neurological and functional outcomes at discharge from hospital and at follow up at 6 months and
at the first year. We want to find as well a cut-off point, which in the first 24 hours allow clinicians to
classify patients who had suffered a cardiac arrest successfully resuscitated according to their
neurological outcomes.
Design: it will be a multi-centric prospective cohort study involving the coronary care units of
Hospital Universitari Josep Trueta (Girona), Hospital Universitari de la Vall d’Hebron (Barcelona),
Hospital Universitari de la Santa Creu i Sant Pau (Barcelona), Hospital Universitari de Bellvitge
(Hospitalet del Llobregat) and Hospital Universitari Germans Trias i Pujol (Badalona).
Methods: 330 adult patients who have suffered an out-of-hospital cardiac arrest successfully
resuscitated and undergoing therapeutic hypothermia will be included in our study. Since the
moment therapeutic hypothermia starts, all of them will be connected to Bispectral index monitors
by a sensor-strip located in their foreheads. We will record the first 72 hours of Bispectral index
monitoring.
This study will be conducted in three years
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