Neuron specific enolase and Glasgow motor score remain useful tools for assessing neurological prognosis after out-of-hospital cardiac arrest treated with therapeutic hypothermia.
OBJECTIVE
Identifying clinical, electrophysiological and biological predictors for 6-month neurological outcome in survivors at day 3 after cardiac arrest (CA) treated with therapeutic hypothermia (TH).


METHODS
We conducted a retrospective cohort study of adults comatose after out-of hospital CA treated with TH. All data were collected from medical charts and laboratory files.


RESULTS
Between January 2010 and March 2013, among the 130 analysed CA survivors, 27 (21%) had a good neurological outcome at 6 months and 103 (79%) had a poor neurological outcome, including 98 deaths. The Glasgow coma score motor response (GCS-M), pupillary reflexes and Neuron Specific Enolase (NSE) were the three best predictors of neurological outcome (P<0.0001). The area under the Receiver Operating Characteristic curve for NSE was 0.92 [0.84-0.99].


CONCLUSIONS
NSE values, GCS-M scores and pupillary reflexes are the best predictors of poor 6-month outcome after out-of-hospital CA treated with TH. Of these, NSE values have the best-isolated prognostic performance when above 28.8μg/L.
Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: claire.roger@chu-nimes.fr.
Claire
C
Roger
Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: lpalmier@hotmail.fr.
Ludovic
L
Palmier
Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: benjamin.louart@chu-nimes.fr.
Benjamin
B
Louart
UMR 729 MISTEA, department of biostatistics, Montpellier university hospital, avenue Gaston-Giraud, 34093 Montpellier, France. Electronic address: nicolas.molinari@inserm.fr.
Nicolas
N
Molinari
Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: pierre.geraud.claret@chu-nimes.fr.
Pierre-Geraud
PG
Claret
Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: jean.emmanuel.delacoussaye@chu-nimes.fr.
Jean-Emmanuel
JE
de la Coussaye
Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: jean.yves.lefrant@chu-nimes.fr.
Jean-Yves
JY
Lefrant
Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: laurent.muller@chu-nimes.fr.
Laurent
L
Muller
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003128:Coma / Q000628:therapy; D005260:Female; D005602:France; D015600:Glasgow Coma Scale; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012025:Reflex, Pupillary; D012189:Retrospective Studies; D016896:Treatment Outcome
D010751:Phosphopyruvate Hydratase
Cardiac arrest; Neuron-specific enolase; Prognosis; Therapeutic hypothermia