“Early detection of brain death using the Bispectral Index (BIS) in patients treated by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest”

Reply to Pang et al.: “Early detection of brain death using the Bispectral Index (BIS) in patients treated by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest”

“…We agree with Pang et al [1] that hypothermia prolongs effects of both sedatives and anesthetics [6], and that the question is how to use accurately these drugs during mild therapeutic hypothermia for patients after cardiac arrest. Conversely, we disagree on their interpretation that the value of BIS does not really represent the function of brain during mild therapeutic hypothermia: the BIS really represents the brain function, but this is more precisely the brain function by itself which is decreased and unknown in such conditions.…”

“…We thank Dr. Pang et al [1] for their interest and their relevant comments about our article [2]. As they underlined in their letter [1], during therapeutic hypothermia, there is a vaso-constriction and shivering, that result in skin breakdown and increased oxygen consumption [3], the latest being prevented by anesthetics and sedatives infusion.…”

“…We thank Dr. Pang et al [1] for their interest and their relevant comments about our article [2]. As they underlined in their letter [1], during therapeutic hypothermia, there is a vaso-constriction and shivering, that result in skin breakdown and increased oxygen consumption [3], the latest being prevented by anesthetics and sedatives infusion. In the particular context of post-cardiac arrest, the aim of anesthetics and sedatives infusion is also to protect the brain against secondary aggression due to the occurrence of the ischemia-reperfusion syndrome during the first 6 h following a brain injury, which involves mitochondrial dysfunction, reactive oxygen species overproduction and neuro excitotoxicity phenomenon's [4,5].…”

Neurologic outcome after out-of-hospital cardiac arrest could be predicted with the help of bispectral-index during early targeted temperature management

“…A BIS of 0 represents no brain activity, while a BIS of 100 represents complete wakefulness. In terms of reflecting the extent of brain activity of patients, many studies have been conducted on BIS monitoring as an outcome prediction method in a post-cardiac arrest setting to determine its ease of application and interpretation [ 5 – 8 ]. However, to date, the exact method, outcome prediction cut-off values and prediction timing have not been determined.…”