Bispectral index is an indicator of adequate cerebral perfusion during cardiopulmonary resuscitation

Predicting ischemic brain injury after intraoperative cardiac arrest during cardiac surgery using the BIS monitor

“…A BIS value greater than 30 during CPR may be optimal and reassuring of adequate cerebral perfusion [9]. Neither of our patients reached that level after cardiac arrest.…”

“…Even though the BIS monitor is not recommended by Aspect Medical as a cerebral ischemia monitor, it has been used by some to assist in resuscitation during CPR [7][8][9]. There are reports to suggest that BIS monitoring during CPR may be helpful not only in ensuring the adequacy of resuscitation, but also effectiveness of changing techniques such as from external chest compressions to open cardiac massage [9]. A high BIS value reflects cerebral activity and should encourage the team to continue their efforts; however, a low BIS value is more difficult to interpret.…”

“…A low BIS value may be caused by cerebral hypoperfusion [3][4][5][6]. The BIS monitor has also been used to assist medical teams by assessing the adequacy of resuscitative maneuvers during cardiopulmonary resuscitation (CPR) [7][8][9]. However, it has been acknowledged by the manufacturer, Aspect Medical Systems (Norwood, MA, USA), that the BIS is currently not an approved monitor for cerebral ischemia.…”

Spectral Entropy Parameters during Rapid Ventricular Pacing for Transcatheter Aortic Valve Implantation

“…In our study, the spectral entropy parameters returned more rapidly than the BIS, probably because of the inherent 30-60 s delay in the smoothing algorithm used to calculate BIS. In two patient cases [24], abrupt circulation collapses after cardiac surgery occurred in conscious patients who were being monitored for sedation by BIS; in the first patient the cardiovascular symptoms were attributable to asystole, while in the second patient they occurred during ventricular fibrillation (VF). The BIS value dropped to near zero in the first patient during the period of hemodynamic instability but increased to values around 40 within 2-3 min after the restoration of circulation.…”

“…The physician should be aware of all of the patient's clinical conditions that exert a direct effect on EEG, since these could also directly influence the DoA value and subsequently lead to unreliable entropy values. In the literature, there are only a couple of case reports [23,24] when the BIS monitor has been used during a sudden hemodynamic collapse or cardiac arrest; in those cases, BIS decreased significantly during the period of hemodynamic instability. As far as we are aware, the impact of the RVP on spectral entropy values under general anesthesia has not been systematically evaluated.…”