심정지 후 자발 순환 회복되어 경도 저체온 요법을 받는 환자에서 BIS의 신경학적 예후 예측인자로서의 유용성 = Bispectral Index as a Predictive Factor for Neurological Outcome in Post- Resuscitated Patients who Undergo Hypothermia

다국어 초록 (Multilingual Abstract)

Purpose: Bispectral index (BIS) is a non-invasive parameter that expresses the level of consciousness using a numerical value that ranges from 0-100. It can be easily conducted at the patient bed-side throughout a day. We studied whether BIS could be used as a predictive factor for neurological outcome in patients who undergo hypothermia after cardiopulmonary resuscitation.
Methods: The prospective study enrolled patients who underwent induced hypothermia with post-resuscitated state after cardiac arrest and presented to Chonnam National University Hospital from June, 2010 to October,2010. BIS monitoring was conducted from admission at the intensive care unit until normal temperature was attained after the induction of hypothermia. The patients were divided into two groups based on neurological outcome at discharge and the values obtained from BIS monitoring were compared.
Results: Fourteen patients were included in this study. The mortality rate was 28.6% and five patients were discharged with Glasgow Pittsburgh Cerebral Performance Categories 1 or 2. The value of BIS at the start of rewarming was significantly different between the two groups according to neurological outcome, while the value of BIS upon reaching normal temperature did not differ statistically. The significant difference between the two groups was observed in the value of BIS from 19 hours after starting hypothermia.
Conclusion: BIS can be used to predict the neurological outcome of patients who undergo resuscitation after cardiac arrest.

참고문헌 (Reference)

1 박성욱, "혈청 S100B 단백질과 신경특이에놀레이즈: 심정지 후 순환회복된 환자에서 신경 학적 예후 예측 표지자로서의 유용성과 시간에 따른 변화" 대한응급의학회 19 (19): 648-656, 2008

2 송요선, "심정지 후 혼수 환자에서 다중 뇌유발전위 검사의 예후 예측의 유용성" 대한응급의학회 19 (19): 94-101, 2008

3 Torbey MT, "uantitative analysis of the loss of distinction betweengray and white matter in comatose patients after cardiacarrest" 31 : 2163-2167, 2000

4 Shibata S, "Use ofthe bispectral index during the early postresuscitativephase after out-of-hospital cardiac arrest" 19 : 243-246, 2005

5 Zandbergen EG, "Systematic review of early prediction ofpoor outcome in anoxic-ischaemic coma" 352 : 1808-1812, 1998

6 Wijman CA, "Prognostic value of brain diffusionweighted image after cardiac arrest" 65 : 394-402, 2009

7 Prohl J, "Prediction of short term and long termoutcomes after cardiac arrest: A prospective multivariateapproach combining biochemical, clinical, electrophysiological,and neuropsychological investigation" 35 : 1230-1237, 2007

8 Leary M, "Neurologic prognostication andbispectral index monitoring after resuscitation from cardiacarrest" 81 : 1133-1137, 2010

9 LeBlanc JM, "Kane-Gill SL. Role of the bispectralindex in sedation monitoring in the ICU" 40 : 490-500, 2006

10 Booth CM, "Is thispatient dead, vegetative, or severely neurologicallyimpaired? Assessing outcome for comatose survivors ofcardiac arrest" 291 : 870-879, 2004

11 Sugerman NT, "Hospital based use of therapeutichypothermia after cardiac arrest in adults" 26 : 371-376, 2009

12 Bruhn J, "Electromyographicactivity falsely elevates the bispectral index" 92 : 1485-1487, 2000

13 Fodale V, "Coadministration ofpropofol and midazolam decreases bispectral index valueas a result of synergic muscle relaxant action on the motorsystem" 101 : 799-, 2004

14 Fa´bregas N, "Can bispectral index monitoring predictrecovery of consciousness in patients with severebrain injury" 101 : 43-51, 2004

15 Chollet-Xe´mard C, "Bispectral index monitoring is uselessduring cardiac arrest patients’ resuscitation" 80 : 213-216, 2009

16 Pawlik MT, "Bispectral index monitoring during cardiopulmonaryresuscitation repeated twice within 8 days in the samepatient: a case report" 1 : 209-212, 2008

17 Stammet P, "Bispectral index (BIS) helps predicting bad neurologicaloutcome in comatose survivors after cardiac arrest andinduced therapeutic hypothermia" 80 : 437-442, 2010

18 Kearse LA Jr., "Bispectral analysis of the electroencephalogramcorrelates with patient movement to skin incisionduring propofol/nitrous oxide anesthesia" 81 : 1365-1370, 1994