Neuron-specific enolase level predicts survival of patients after cardiopulmonary resuscitation

Background

The prediction of outcome in patients after prolonged cardiopulmonary resuscitation (CPR) has enormous ethical and socioeconomic implications. The present study investigated the prognostic relevance of the early time course of serum neuron-specific enolase (NSE) as a biochemical marker of ischemic brain injury in individuals after CPR.

Methods and results

NSE levels were assessed immediately after restoration of spontaneous circulation (ROSC), 6 hours, 12 hours, and 2 days following prolonged CPR from nontraumatic, normothermic, inhospital or out-of-hospital cardiac arrest in eight male and 12 female patients. The survival status was assessed during the entire hospital stay.

NSE levels in survivors and nonsurvivors immediately after ROSC, 6 hours, 12 hours, and 48 hours after following prolonged CPR were 18.8 ± 13.8 μg/l, 18 ± 7.9 μg/l, 17.9 ± 10.1 μg/l, 14.4 ± 7.1 μg/l, and 26.5 ± 15 μg/l, 49.3 ± 65.5 μg/l, 60.8 ± 72 μg/l, 86.5 ± 87.6 μg/l, respectively. Nonsurvivors had significantly higher NSE levels 48 hours after ROSC than survivors (P = 0.03) and showed a strong trend towards higher values during the entire time course following CPR. NSE concentrations at 48 hours after ROSC of > 23 μg/l and > 29.5 μg/l predicted death with a high specificity (95% and 100%, respectively). In contrast, NSE levels of 15 μg/l or less at 48 hours predicted survival with a high specificity (100%).

Conclusion

Serum NSE levels early after ROSC are valuable additional parameters for the prediction of outcome in patients after prolonged CPR.

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