CONGRESS ABSTRACT

In our cardiac intensive care unit (ICU), we recently introduced bispectral index (BIS) monitoring to manage comatose patients after resuscitation from cardiac arrest. BIS monitoring analyzes electroencephalographic (EEG) signal detected by electrodes placed on the forehead. It provides a simplified EEG trace, a spectroscopic representation of brain activity, and a numerical value indicating the depth of sedation. We hypothesize that BIS monitoring may aid in the early detection of status epilepticus in comatose, sedated patients and contribute to neurological prognostication, particularly in those with severely reduced brain activity. We retrospectively analyzed data from comatose patients admitted to our cardiac ICU after cardiac arrest between January 2023 and August 2024. Patients who died within six hours from admission or lacked BIS monitoring data were excluded. For all included patients, we recorded the mean BIS value during the first 24 hours of hospitalization and evaluated the simplified EEG trace for signs of cerebral epileptic activity. Neurological outcomes were assessed at 30 days using the cerebral performance category (CPC) scale. Of 15 patients, 5 (33%) had favorable neurological outcome (CPC 1–2), while 10 (67%) had unfavorable outcome (CPC 3–5). The mean BIS value during the first 24 hours was 41 in patients with favorable outcome and 15 in those with poor outcome. Sedation protocols based on morphine and propofol was the same in the two groups. Cerebral epileptic activity was suspected on the BIS EEG trace in 5 patients (33%) and confirmed in all cases by standard EEG. Post-cardiac arrest syndrome is a complex condition, with post-anoxic brain injury playing a critical role in prognosis. Although experience with BIS monitoring in this context remains limited, it shows potential for early recognition and management of status epilepticus. Additionally, it may serve as a valuable component in a multiparametric approach to neuroprognostication.