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Chiu WT, Lin KC, Tsai MS, Hsu CH, Wang CH, Kuo LK, Chien YS, Wu CH, Lai CH, Huang WC, Wang CH, Wang TL, Hsu HH, Lin JJ, Hwang JJ, Ng CJ, Choi WM, Huang CH. Post-cardiac arrest care and targeted temperature management: A consensus of scientific statement from the Taiwan Society of Emergency & Critical Care Medicine, Taiwan Society of Critical Care Medicine and Taiwan Society of Emergency Medicine. J Formos Med Assoc 2021; 120:569-587. [PMID: 32829996 DOI: 10.1016/j.jfma.2020.07.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/07/2020] [Accepted: 07/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Post-cardiac arrest care is critically important in bringing cardiac arrest patients to functional recovery after the detrimental event. More high quality studies are published and evidence is accumulated for the post-cardiac arrest care in the recent years. It is still a challenge for the clinicians to integrate these scientific data into the real clinical practice for such a complicated intensive care involving many different disciplines. METHODS With the cooperation of the experienced experts from all disciplines relevant to post-cardiac arrest care, the consensus of the scientific statement was generated and supported by three major scientific groups for emergency and critical care in post-cardiac arrest care. RESULTS High quality post-cardiac arrest care, including targeted temperature management, early evaluation of possible acute coronary event and intensive care for hemodynamic and respiratory care are inevitably needed to get full recovery for cardiac arrest. Management of these critical issues were reviewed and proposed in the consensus CONCLUSION: The goal of the statement is to provide help for the clinical physician to achieve better quality and evidence-based care in post-cardiac arrest period.
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Affiliation(s)
- Wei-Ting Chiu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan, ROC
| | - Kun-Chang Lin
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - Chih-Hsin Hsu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital Dou Liou Branch, College of Medicine, National Cheng Kung University, Taiwan
| | - Chen-Hsu Wang
- Attending Physician, Coronary Care Unit, Cardiovascular Center, Cathay General Hospital, Taipei, Taiwan
| | - Li-Kuo Kuo
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei Branch, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Yu-San Chien
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei Branch, Taiwan
| | - Cheng-Hsueh Wu
- Department of Critical Care Medicine, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Hung Lai
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
| | - Chih-Hsien Wang
- Cardiovascular Surgery, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - Tzong-Luen Wang
- Chang Bing Show Chwang Memorial Hospital, Changhua, Taiwan; School of Medicine and Law, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Hsin-Hui Hsu
- Department of Critical Care Medicine, Changhua Christian Hospital, Taiwan
| | - Jen-Jyh Lin
- Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Respiratory Therapy, China Medical University, Taichung, Taiwan, ROC
| | - Juey-Jen Hwang
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Wai-Mau Choi
- Department of Emergency Medicine, Hsinchu MacKay Memorial Hospital, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan; Cardiovascular Division, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taiwan.
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Chang CY, Chen CS, Chien YJ, Lin PC, Wu MY. The Effects of Early Bispectral Index to Predict Poor Neurological Function in Cardiac Arrest Patients: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2020; 10:diagnostics10050271. [PMID: 32365854 PMCID: PMC7277843 DOI: 10.3390/diagnostics10050271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 01/14/2023] Open
Abstract
The diagnostic performance of the bispectral index (BIS) to early predict neurological outcomes in patients achieving return of spontaneous circulation (ROSC) after cardiac arrest (CA) remained unclear. We searched PubMed, EMBASE, Scopus and CENTRAL for relevant studies through October 2019. Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Meta-analysis was performed using a linear mixed-effects model to the log-transformed data with a logistic distribution assumption. Bivariate meta-regression was performed to explore heterogeneity. In total, 13 studies with 999 CA adult patients were included. At the optimal threshold of 32, BIS obtained within 72 h of ROSC elicits a pooled sensitivity of 84.9% (95% confidence interval (CI), 71.1% to 92.7%), a pooled specificity of 85.9% (95% CI, 71.2% to 93.8%) and an area under the curve of 0.92. Moreover, a BIS cutoff < 12 yielded a pooled specificity of 95.0% (95% CI, 77.8% to 99.0%). In bivariate meta-regression, the timing of neurological outcome assessment, the adoption of targeted temperature management, and the administration of sedative agents or neuromuscular blocking agents (NMBA) were not identified as the potential source of heterogeneity. BIS retains good diagnostic performance during targeted temperature management (TTM) and in the presence of administrated sedative agents and NMBA. In conclusion, BIS can predict poor neurological outcomes early in patients with ROSC after CA with good diagnostic performance and should be incorporated into the neuroprognostication strategy algorithm.
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Affiliation(s)
- Chun-Yu Chang
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan;
| | - Chien-Sheng Chen
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan; (C.-S.C.); (P.-C.L.)
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Yung-Jiun Chien
- Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan;
| | - Po-Chen Lin
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan; (C.-S.C.); (P.-C.L.)
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan; (C.-S.C.); (P.-C.L.)
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Correspondence: ; Tel.: +8869-861-72752
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Tian F, Liu T, Xu G, Ghazi T, Sajjad A, Farrehi P, Wang MM, Borjigin J. Surge of corticocardiac coupling in SHRSP rats exposed to forebrain cerebral ischemia. J Neurophysiol 2019; 121:842-852. [PMID: 30625009 DOI: 10.1152/jn.00533.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sudden death is an important but underrecognized consequence of stroke. Acute stroke can disturb central control of autonomic function and result in cardiac dysfunction and sudden death. Previous study showed that bilateral common carotid artery ligation (BCCAL) in the spontaneously hypertensive stroke-prone rat strain (SHRSP) is a well-established model for forebrain ischemic sudden death. This study aims to investigate the temporal dynamic changes in electrical activities of the brain and heart and functional interactions between the two vital organs following forebrain ischemia. EEG and ECG signals were simultaneously collected from nine SHRSP and eight Wistar-Kyoto (WKY) rats. RR interval was analyzed to investigate the cardiac response to brain ischemia. EEG power and coherence (CCoh) analysis were conducted to study the cortical response. Corticocardiac coherence (CCCoh) and directional connectivity (CCCon) were analyzed to determine brain-heart connection. Heart rate variability (HRV) was analyzed to evaluate autonomic functionality. BCCAL resulted in 100% mortality in SHRSP within 14 h, whereas no mortality was observed in WKY rats. The functionality of both the brain and the heart were significantly altered in SHRSP compared with WKY rats after BCCAL. SHRSP, but not WKY rats, exhibited intermittent surge of CCCoh, which paralleled the elevated CCCon and reduced HRV, following the onset of ischemia until sudden death. Elevated brain-heart coupling invariably associated with the disruption of the autonomic nervous system and the risk of sudden death. This study may improve our understanding of the mechanism of forebrain ischemia-induced sudden death. NEW & NOTEWORTHY This study demonstrates a marked surge of corticocardiac coupling in rats dying from focal cerebral ischemia, consistent with our earlier data in rats exposed to fatal asphyxia. Since the bidirectional electrical signal coupling (corticocardiac coherence) and communication (corticocardiac connectivity) between the brain and the heart are only identified in dying animals, they could be used as potential biomarkers to predict the risk of sudden death.
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Affiliation(s)
- Fangyun Tian
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Tiecheng Liu
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Gang Xu
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Talha Ghazi
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Azeem Sajjad
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan
| | - Peter Farrehi
- Cardiovascular Center, University of Michigan , Ann Arbor, Michigan.,Department of Internal Medicine-Cardiology, University of Michigan , Ann Arbor, Michigan
| | - Michael M Wang
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan.,Department of Neurology, University of Michigan , Ann Arbor, Michigan.,Neuroscience Graduate Program, University of Michigan , Ann Arbor, Michigan.,Cardiovascular Center, University of Michigan , Ann Arbor, Michigan.,Veterans Administration Ann Arbor Healthcare System , Ann Arbor, Michigan
| | - Jimo Borjigin
- Department of Molecular and Integrative Physiology, University of Michigan , Ann Arbor, Michigan.,Department of Neurology, University of Michigan , Ann Arbor, Michigan.,Neuroscience Graduate Program, University of Michigan , Ann Arbor, Michigan.,Cardiovascular Center, University of Michigan , Ann Arbor, Michigan.,Michigan Center for Integrative Research in Critical Care, University of Michigan , Ann Arbor, Michigan
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Park JH, Oh JH, Choi SP, Wee JH. Neurologic outcome after out-of-hospital cardiac arrest could be predicted with the help of bispectral-index during early targeted temperature management. Scand J Trauma Resusc Emerg Med 2018; 26:59. [PMID: 30005682 PMCID: PMC6045863 DOI: 10.1186/s13049-018-0529-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 07/06/2018] [Indexed: 12/19/2022] Open
Abstract
Background Outcome prediction is crucial for out-of-hospital cardiac arrest (OHCA) survivors. Several attempts have been made to use the bispectral index (BIS) for this purpose. We aimed to investigate the prognostic power of the BIS during the early stage of targeted temperature management (TTM) after OHCA. Methods From Jan 2014 to Feb 2017, the BIS was determined in OHCA patients as soon as possible after the start of TTM. We injected a neuro-muscular blocking agent and recoded the BIS value and the time when the electromyographic (EMG) factor reached zero. The primary outcome was the cerebral performance category scale (CPC) score at 6 months, and a poor outcome was defined as a CPC score of 3, 4, or 5. The exclusion criteria were age under 18 years, traumatic cardiac arrest, and BIS data with a non-zero EMG factor. Results Sixty-five patients were included in this study. Good outcomes were observed for 16 patients (24.6%), and poor outcomes were observed for 49 patients (75.4%). The mean time of BIS recording was 2.3 ± 1.0 h after return of spontaneous circulation (ROSC). The mean BIS values of the good outcome and poor outcome groups were 35.6 ± 13.1 and 5.5 ± 9.2, respectively (p < 0.001). The area under the curve was 0.961. Use of a cut-off value of 20.5 to predict a good outcome yielded a sensitivity of 87.5% and specificity of 93.9%. Use of a cut-off value of 10.5 to predict a poor outcome yielded a sensitivity of 87.8% and specificity of 100%. Conclusion With the help of BIS, physicians could predict that a patient who has BIS value over 20.5 after ROSC could have a big chance to get good neurological outcome in less than three hours.
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Affiliation(s)
- Jeong Ho Park
- Department of Emergency Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Jae Hun Oh
- Department of Emergency Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Seung Pill Choi
- Department of Emergency Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Jung Hee Wee
- Department of Emergency Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea.
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The validation of simplified EEG derived from the bispectral index monitor in post-cardiac arrest patients. Resuscitation 2018; 126:179-184. [DOI: 10.1016/j.resuscitation.2018.01.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/11/2018] [Accepted: 01/27/2018] [Indexed: 01/12/2023]
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Asgari S, Moshirvaziri H, Scalzo F, Ramezan-Arab N. Quantitative measures of EEG for prediction of outcome in cardiac arrest subjects treated with hypothermia: a literature review. J Clin Monit Comput 2018; 32:977-992. [DOI: 10.1007/s10877-018-0118-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 02/22/2018] [Indexed: 12/14/2022]
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