Abstract
Objective.
The aim of this study was to investigate whether serial serum neuron-specific enolase (NSE) can be used to predict neurological prognosis in patients remaining comatose after cardiopulmonary resuscitation (CPR).
Design.
Observational cohort study. Clinicians were blinded to NSE results.
Setting.
Eighteen-bed general ICU.
Patients.
Comatose patients admitted to the ICU after CPR.
Interventions.
Serum NSE was measured at admission and daily for 5 days.
Measurements and results.
Patients received full intensive treatment until recovery or until absence of cortical response to somatosensory evoked potentials more than 48 h after CPR proved irreversible coma. Of the 110 patients included (mean GCS at ICU admission 3, range 3––9), 34 regained consciousness, five of whom died in hospital. Seventy-six patients did not regain consciousness, 72 of whom died in hospital. Serum NSE at 24 h and at 48 h after CPR was significantly higher in patients who did not regain consciousness than in patients who regained consciousness (at 24 h: median NSE 29.9 µg/l, range 1.8–250 vs 9.9 µg/l, range 4.5–21.5, P <0.001; at 48 h: median 37.8 µg/l, range 4.4–411 vs 9.5 µg/l, range 6.2–22.4, P = 0.001). No patient with a serum NSE level >25.0 µg/l at any time regained consciousness. Addition of NSE to GCS and somatosensory evoked potentials increased predictability of poor neurological outcome from 64% to 76%.
Conclusions.
High serum NSE levels in comatose patients at 24 h and 48 h after CPR predict a poor neurological outcome. Addition of NSE to GCS and somatosensory evoked potentials increases predictability of neurological outcome.
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Meynaar, I.A., Straaten, H.M.Ov., van der Wetering, J. et al. Serum neuron-specific enolase predicts outcome in post-anoxic coma: a prospective cohort study. Intensive Care Med 29, 189–195 (2003). https://doi.org/10.1007/s00134-002-1573-2
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DOI: https://doi.org/10.1007/s00134-002-1573-2