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Roberti E, Chiarini G, Latronico N, Adami EC, Plotti C, Bonetta E, Magri F, Rasulo FA. Electroencephalographic monitoring of brain activity during cardiac arrest: a narrative review. Intensive Care Med Exp 2023; 11:4. [PMID: 36658406 PMCID: PMC9852381 DOI: 10.1186/s40635-022-00489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/22/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To date cardiac arrest (CA) remains a frequent cause of morbidity and mortality: despite advances in cardiopulmonary resuscitation (CPR), survival is still burdened by hypoxic-ischemic brain injury (HIBI), and poor neurological outcome, eventually leading to withdrawal of life sustaining treatment (WLST). The aim of CPR is cardiac pump support to preserve organ perfusion, until normal cardiac function is restored. However, clinical parameters of target organ end-perfusion during CPR, particularly brain perfusion, are still to be identified. In this context, electroencephalography (EEG) and its derivatives, such as processed EEG, could be used to assess brain function during CA. OBJECTIVES We aimed to review literature regarding the feasibility of EEG and processed or raw EEG monitoring during CPR. METHODS A review of the available literature was performed and consisted of mostly case reports and observational studies in both humans and animals, for a total number of 22 relevant studies. RESULTS The research strategy identified 22 unique articles. 4 observational studies were included and 6 animal testing studies in swine models. The remaining studies were case reports. Literature regarding this topic consists of conflicting results, containing studies where the feasibility of EEG during CPR was positive, and others where the authors reached opposite conclusions. Furthermore, the level of evidence, in general, remains low. DISCUSSION EEG may represent a useful tool to assess CPR effectiveness. A multimodal approach including other non-invasive tools such as, quantitative infrared pupillometry and transcranial Doppler, could help to optimize the quality of resuscitation maneuvers.
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Affiliation(s)
- Elisabetta Roberti
- grid.7637.50000000417571846Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy ,grid.7637.50000000417571846University of Brescia Residency School in Anesthesiology and Intensive Care Medicine, University of Brescia, Brescia, Italy
| | - Giovanni Chiarini
- grid.412311.4Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Nicola Latronico
- grid.7637.50000000417571846Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy ,grid.412311.4Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Enrica Chiara Adami
- grid.412725.7Cardiothoracic Intensive Care Unit, Cardiothoracic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Chiara Plotti
- grid.7637.50000000417571846Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy ,grid.7637.50000000417571846University of Brescia Residency School in Anesthesiology and Intensive Care Medicine, University of Brescia, Brescia, Italy
| | - Elisa Bonetta
- grid.7637.50000000417571846Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy ,grid.7637.50000000417571846University of Brescia Residency School in Anesthesiology and Intensive Care Medicine, University of Brescia, Brescia, Italy
| | - Federica Magri
- grid.7637.50000000417571846Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy ,grid.7637.50000000417571846University of Brescia Residency School in Anesthesiology and Intensive Care Medicine, University of Brescia, Brescia, Italy
| | - Frank Anthony Rasulo
- grid.7637.50000000417571846Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
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Miao W, Sun Q, Wang H, Li H. The maximum value of bispectral index predicts outcome in hypoxic-ischemic encephalopathy after resuscitation, better than minimum or mean value. Brain Inj 2018; 32:1135-1141. [PMID: 29851509 DOI: 10.1080/02699052.2018.1476732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Although bispectral index (BIS) has been widely used for predicting neurological outcomes in clinical practice, its optimal value concerning maximum (BISmax), minimum (BISmin) and mean (BISmean) on accurately predicting the prognosis of patients with hypoxic-ischemic encephalopathy (HIE) after resuscitation has not been clearly determined. METHODS For a total number of 45 cases, the duration of each BIS measurement was 12 h, with the data collected at a 30 min interval. Outcome was recorded as survival and non-survival count 60 days after the resuscitation. Receiver operator characteristic curve was used to assess the BISmax, BISmin and BISmean for predicting clinical outcome. RESULTS By the end of observation, 20 cases (44.4%) survived with a significantly higher BISmax. The area under the curve for BISmax of predicting survival was the highest compared to BISmin and BISmean. The optimal cut-off value of BISmax was 71.5 with 100% sensitivity and 60% specificity. Ten patients presented BIS value down to zero at any time point did not survive the observation. CONCLUSION The BISmax is a better outcome predictor than BISmin or BISmean for patients with HIE after resuscitation. Lower BISmax represents higher risk of mortality. Additionally, BIS value decreases to zero represents a poor outcome.
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Affiliation(s)
- Wenli Miao
- a Department of Critical Care Medicine , No. 401 Hospital of the Chinese Peoples' Liberation Army , Qingdao , China.,b Department of Critical Care Medicine , Huikang Hospital of Qingdao University Medical Group , Qingdao , China
| | - Qing Sun
- c Department of Hyperbaric Medicine , No. 401 Hospital of the Chinese Peoples' Liberation Army , Qingdao , China
| | - Hongdao Wang
- a Department of Critical Care Medicine , No. 401 Hospital of the Chinese Peoples' Liberation Army , Qingdao , China
| | - Hailing Li
- a Department of Critical Care Medicine , No. 401 Hospital of the Chinese Peoples' Liberation Army , Qingdao , China
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Return of consciousness during ongoing cardiopulmonary resuscitation: A systematic review. Resuscitation 2014; 86:44-8. [PMID: 25447435 DOI: 10.1016/j.resuscitation.2014.10.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/08/2014] [Accepted: 10/28/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Cardio-pulmonary resuscitation (CPR) may generate sufficient cerebral perfusion pressure to make the patient conscious. The incidence and management of this phenomenon are not well described. This systematic review aims to identifying cases where CPR-induced consciousness is mentioned in the literature and explore its management options. METHODS The databases Medline, PubMed, EMBASE, Cinahl and the Cochrane Library were searched from their commencement to the 8th July 2014. We also searched Google (scholar) for grey literature. We combined MeSH terms and text words for consciousness and CPR, and included studies of all types. RESULTS The search yielded 1997 unique records, of which 50 abstracts were reviewed. Nine reports, describing 10 patients, were relevant. Six of the patients had CPR performed by mechanical devices, three of these patients were sedated. Four patients arrested in the out-of-hospital setting and six arrested in hospital. There were four survivors. Varying levels of consciousness were described in all reports, including purposeful arm movements, verbal communication, and resuscitation interference. Management strategies directed at consciousness were offered to six patients and included both physical and chemical restraints. CONCLUSION CPR-induced consciousness was infrequently reported in the medical literature, and varied in management. Given the increasing use of mechanical CPR, guidelines to identify and manage consciousness during CPR are required.
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