Bispectral index during cardiopulmonary resuscitation: a poor indicator of recovery. Two very different cases

We report two cases of massive intra-operative bleeding during lung transplantation requiring emergency cardiopulmonary bypass. In both cases the bispectral index dropped to 0, remained low for around 30 and 90 min respectively, and then returned to values consistent with a usual anaesthetic state (around 40). At the time bispectral monitoring provided some reassurance to the medical team about the adequacy of the resuscitation. However, this proved misleading since postoperative neurological recovery was favourable in one case but not in the other.