title: Neurological Prognostication of Cardiac Arrest in an Era of Extracorporeal Membrane Oxygenation.
abstract: A neuron-specific enolase level greater than 33 ng/mL at days 1 to 3 or status myoclonus within 1 day are traditional indicators of poor neurological prognosis in survivors of cardiac arrest. We report the case of a 70-year-old man who received extracorporeal membrane oxygenation following cardiac arrest. Despite having both an elevated neuron-specific enolase concentration of 68 ng/mL and status myoclonus, he made an excellent neurological recovery. The value of traditional markers of poor prognosis such as elevated neuron-specific enolase or status myoclonus has not been systematically validated in patients treated with extracorporeal membrane oxygenation or therapeutic hypothermia. Straightforward application of practice guidelines in these cases may result in tragic outcomes. This case underscores the need for reliable prognostic markers that account for recent advances in cardiopulmonary and neurological therapies.
authors.affiliation: Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Supreet K
authors.initials: SK
authors.lastname: Sahai
authors.affiliation: Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Majic
authors.affiliation: Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: Jignesh
authors.initials: J
authors.lastname: Patel
authors.affiliation: Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Nurok
authors.affiliation: Departments of Neurology and Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Asma M
authors.initials: AM
authors.lastname: Moheet
authors.affiliation: Departments of Neurology and Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Axel J
authors.initials: AJ
authors.lastname: Rosengart
authors.affiliation: Departments of Neurology and Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Shouri
authors.initials: S
authors.lastname: Lahiri
keywords: clinical specialty; coma; neurocritical care; neuron-specific enolase; prognosis; status myoclonus