Abstract 249: Neurocardiac Triage: A Classification Scheme to Guide Post Resuscitation Cardiac Arrest Care
Introduction: We previously described use of the bispectral index (BIS), a processed EEG modality that integrates EEG power, reactivity, and suppression ratio, to assess severity of hypoxic-ischemic brain injury (HIE) very early after cardiac arrest. We now propose a neurocardiac triage model based on bispectral index and coronary risk, and describe patient outcomes accordingly.
Methods: Patients from our prospective cardiac arrest database were retrospectively classified by four cardiac risk groups: STEMI, VT/VF with shock, VT/VF without shock, and PEA/asystole. Neurological injury was described by the “BISi”-the BIS score recorded immediately after the first dose of neuromuscular blockade, and classified as mild (BISi>20), moderate (BISi 10-20), or severe (BISi<10).
Results: The BISi was determined at (270±186) minutes after resuscitation (ROSC). Thirty-three patients presented with STEMI; 9 of these had severe HIE - 6 later died of neurological and 1 of cardiac causes. Sixteen patients with STEMI had mild HIE: none died of neurological and 1 of cardiac cause. Fifteen patients presented with VT/VF and shock: 5 had severe HIE - 4 died of neurological and 1 of cardiac etiology. Nine patients with VT/VF and shock had mild HIE: none died of neurological and 4 of cardiac etiology. Of 41 patients with VT/VF and without shock, 16 had severe HIE: 10 died of neurological and 2 of cardiac etiology, 22 had mild brain injury - 2 each died of neurological and cardiac causes. Finally, 80 patients had PEA/asystole; 36 of these had severe HIE - 34 died of neurological and 2 of cardiac causes. Thirty-four patients with PEA/asystole had mild HIE - 8 died of neurological and 9 of cardiac causes. Thirty-eight patients in the total cohort underwent urgent cardiac catheterization (CC) - 8 (21.1%) subsequently died of neurological causes; 5 of those 8 were identified as severe HIE by BISi. Of 56 non-STEMI patients with VT/VF (with or without shock), 24 were identified as having mild HIE yet did not undergo urgent CC - 5 (20.8%) of those patients subsequently died of a cardiac cause.
Conclusion: A neurocardiac triage model based on early processed EEG and cardiac risk class suggested possible utility in selecting appropriate patients for urgent coronary angiography and PCI after cardiac arrest.
- © 2013 by American Heart Association, Inc.