Neuron-specific enolase correlates with other prognostic markers after cardiac arrest.
Cronberg, Tobias LU ; Rundgren, Malin LU ; Westhall, Erik LU ; Englund, Elisabet LU
; Siemund, Roger
LU
; Rosén, Ingmar
LU
; Widner, Håkan
LU
and Friberg, Hans
LU
(2011)
In Neurology
77(7).
p.623-630
- Abstract
- OBJECTIVE: Therapeutic hypothermia (TH) is a recommended treatment for survivors of cardiac arrest. Prognostication is complicated since sedation and muscle relaxation are used and established indicators of a poor prognosis are lacking. This prospective, observational study describes the pattern of commonly used prognostic markers in a hypothermia-treated cohort of cardiac arrest patients with prolonged coma. METHODS: Among 111 consecutive patients, 19 died, 58 recovered, and 34 were in coma 3 days after normothermia (4.5 days after cardiac arrest), defined as prolonged coma. All patients were monitored with continuous amplitude-integrated EEG and repeated samples of neuron-specific enolase (NSE) were collected. In patients with prolonged... (More)
- OBJECTIVE: Therapeutic hypothermia (TH) is a recommended treatment for survivors of cardiac arrest. Prognostication is complicated since sedation and muscle relaxation are used and established indicators of a poor prognosis are lacking. This prospective, observational study describes the pattern of commonly used prognostic markers in a hypothermia-treated cohort of cardiac arrest patients with prolonged coma. METHODS: Among 111 consecutive patients, 19 died, 58 recovered, and 34 were in coma 3 days after normothermia (4.5 days after cardiac arrest), defined as prolonged coma. All patients were monitored with continuous amplitude-integrated EEG and repeated samples of neuron-specific enolase (NSE) were collected. In patients with prolonged coma, somatosensory evoked potentials (SSEP) and brain MRI were performed. A postmortem brain investigation was undertaken in patients who died. RESULTS: Six of the 17 patients (35%) with NSE levels <33 μg/L at 48 hours regained the capacity to obey verbal commands. By contrast, all 17 patients with NSE levels >33 failed to recover consciousness. In the >33 NSE group, all 10 studied with MRI had extensive brain injury on diffusion-weighted images, 12/16 lacked cortical responses on SSEP, and all 6 who underwent autopsy had extensive severe histologic damage. NSE levels also correlated with EEG pattern, but less uniformly, since 11/17 with NSE <33 had an electrographic status epilepticus (ESE), only one of whom recovered. A continuous EEG pattern correlated to NSE <33 and awakening. CONCLUSIONS: NSE correlates well with other markers of ischemic brain injury. In patients with no other signs of brain injury, postanoxic ESE may explain a poor outcome. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/2058424
- author
- Cronberg, Tobias
LU
; Rundgren, Malin
LU
; Westhall, Erik
LU
; Englund, Elisabet
LU
; Siemund, Roger
LU
; Rosén, Ingmar
LU
; Widner, Håkan
LU
and Friberg, Hans
LU
- organization
- publishing date
- 2011
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Neurology
- volume
- 77
- issue
- 7
- pages
- 623 - 630
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- wos:000293881600008
- pmid:21775743
- scopus:80055085732
- ISSN
- 1526-632X
- DOI
- 10.1212/WNL.0b013e31822a276d
- language
- English
- LU publication?
- yes
- additional info
- The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Diagnostic Radiology, (Lund) (013038000), Pathology, (Lund) (013030000), Clinical Neurophysiology (013013001), Anaesthesiology and Intensive Care (013230022), Neurology, Lund (013027000)
- id
- d0d81a59-1e98-499e-ac6c-09ce3e67f8c6 (old id 2058424)
- alternative location
- http://www.ncbi.nlm.nih.gov/pubmed/21775743?dopt=Abstract
- date added to LUP
- 2016-04-04 09:18:21
- date last changed
- 2022-05-16 23:48:54
@article{d0d81a59-1e98-499e-ac6c-09ce3e67f8c6,
abstract = {{OBJECTIVE: Therapeutic hypothermia (TH) is a recommended treatment for survivors of cardiac arrest. Prognostication is complicated since sedation and muscle relaxation are used and established indicators of a poor prognosis are lacking. This prospective, observational study describes the pattern of commonly used prognostic markers in a hypothermia-treated cohort of cardiac arrest patients with prolonged coma. METHODS: Among 111 consecutive patients, 19 died, 58 recovered, and 34 were in coma 3 days after normothermia (4.5 days after cardiac arrest), defined as prolonged coma. All patients were monitored with continuous amplitude-integrated EEG and repeated samples of neuron-specific enolase (NSE) were collected. In patients with prolonged coma, somatosensory evoked potentials (SSEP) and brain MRI were performed. A postmortem brain investigation was undertaken in patients who died. RESULTS: Six of the 17 patients (35%) with NSE levels <33 μg/L at 48 hours regained the capacity to obey verbal commands. By contrast, all 17 patients with NSE levels >33 failed to recover consciousness. In the >33 NSE group, all 10 studied with MRI had extensive brain injury on diffusion-weighted images, 12/16 lacked cortical responses on SSEP, and all 6 who underwent autopsy had extensive severe histologic damage. NSE levels also correlated with EEG pattern, but less uniformly, since 11/17 with NSE <33 had an electrographic status epilepticus (ESE), only one of whom recovered. A continuous EEG pattern correlated to NSE <33 and awakening. CONCLUSIONS: NSE correlates well with other markers of ischemic brain injury. In patients with no other signs of brain injury, postanoxic ESE may explain a poor outcome.}},
author = {{Cronberg, Tobias and Rundgren, Malin and Westhall, Erik and Englund, Elisabet and Siemund, Roger and Rosén, Ingmar and Widner, Håkan and Friberg, Hans}},
issn = {{1526-632X}},
language = {{eng}},
number = {{7}},
pages = {{623--630}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Neurology}},
title = {{Neuron-specific enolase correlates with other prognostic markers after cardiac arrest.}},
url = {{http://dx.doi.org/10.1212/WNL.0b013e31822a276d}},
doi = {{10.1212/WNL.0b013e31822a276d}},
volume = {{77}},
year = {{2011}},
}