Optimizing neurologic prognosis after cardiac arrest.
Neurologic disability is a feared outcome of resuscitation from cardiac arrest. The study by Rech and colleagues in the previous issue of Critical Care describes the use of neuron-specific enolase to inform an early prognosis in patients who survived in-hospital cardiac arrest. In their study 'none of the patients had a DNR order and there was no limitation of life support.' As a result, 10% of patients remained in a vegetative state at 6 months, a higher percentage than in other recent studies. The existence of a population of patients in which all are fully supported without withholding care or withdrawal of care may represent an important research opportunity. High neuron-specific enolase levels have been reported in patients that awoke and seem to occur in studies with a higher percentage of patients in a vegetative state at follow-up (more uniform support). If a comprehensive set of clinical, electrophysiological, biochemical and imaging measures could be obtained in a uniform manner in a cohort of patients without limitations in care, a more objective set of comprehensive prognostic indicators could be obtained. A focused international consortium is called for.
Tirschwell
David
D
Harborview Medical Center, University of Washington School of Medicine, 325 Ninth Avenue, Box 359775, Seattle, WA 98104-2499, USA. tirsch@u.washington.edu
D015415:Biomarkers / Q000097:blood; D035843:Biomedical Research; D001925:Brain Damage, Chronic / Q000097:blood* / Q000209:etiology*; D015331:Cohort Studies; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D007391:International Cooperation; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011379:Prognosis; D028761:Withholding Treatment
D015415:Biomarkers; D010751:Phosphopyruvate Hydratase