Early prediction of neurological outcome after cardiopulmonary resuscitation: a multimodal approach combining neurobiochemical and electrophysiological investigations may provide high prognostic certainty in patients after cardiac arrest.
A reliable and reproducible method for precisely predicting the neurological outcome of patients with hypoxic-ischemic encephalopathy after cardiac arrest is urgently needed in neurological intensive care units. We prospectively investigated the predictive power of serum concentrations of neuron-specific enolase (NSE) and protein S-100B (S-100B) measured on days 1, 2, 3 and 7 as well as somatosensory-evoked potentials (SEPs) recorded within 48 h and on day 7 after cardiopulmonary resuscitation (CPR) in 27 patients (14 females, 13 males; mean age 61.3 +/- 17.3 years) with hypoxic-ischemic encephalopathy. During the first 7 days after CPR, median values of NSE and S-100B were increased in patients who remained unconscious after CPR compared to those patients who regained consciousness (significance up to < or =0.001). The best predictor of negative outcome was an NSE cutoff point > or =43 microg/l on day 2; this had a sensitivity of 90.9% and a specificity of 100%. Additional use of S-100B on day 2 did not increase sensitivity, but this could be markedly increased by combining NSE and S-100B on days 1, 3 and 7. SEPs showing bilateral loss of cortical responses identified patients who did not regain consciousness with a specificity of 100%.
Zingler
Vera Carina
VC
Department of Neurology, Mannheim Hospital, University of Heidelberg, Mannheim, Germany.
Krumm
Bertram
B
Bertsch
Thomas
T
Fassbender
Klaus
K
Pohlmann-Eden
Bernd
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology; D001921:Brain / Q000378:metabolism*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003128:Coma / Q000175:diagnosis / Q000209:etiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000150:complications / Q000378:metabolism / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017293:Protein S / Q000378:metabolism*; D013997:Time Factors
D017293:Protein S; D010751:Phosphopyruvate Hydratase