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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. 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)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Neurology
volume
77
pages
623 - 630
publisher
American Academy of Neurology
external identifiers
  • wos:000293881600008
  • pmid:21775743
  • scopus:80055085732
ISSN
1526-632X
DOI
10.1212/WNL.0b013e31822a276d
language
English
LU publication?
yes
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
2011-08-01 12:28:47
date last changed
2017-03-26 04:29:38
@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 &lt;33 μg/L at 48 hours regained the capacity to obey verbal commands. By contrast, all 17 patients with NSE levels &gt;33 failed to recover consciousness. In the &gt;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 &lt;33 had an electrographic status epilepticus (ESE), only one of whom recovered. A continuous EEG pattern correlated to NSE &lt;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},
  pages        = {623--630},
  publisher    = {American Academy of Neurology},
  series       = {Neurology},
  title        = {Neuron-specific enolase correlates with other prognostic markers after cardiac arrest.},
  url          = {http://dx.doi.org/10.1212/WNL.0b013e31822a276d},
  volume       = {77},
  year         = {2011},
}