Neuron specific enolase and Glasgow motor score remain useful tools for assessing neurological prognosis after out-of-hospital cardiac arrest treated with therapeutic hypothermia

Claire Roger; Ludovic Palmier; Benjamin Louart; Nicolas Molinari; Pierre-Geraud Claret; Jean-Emmanuel de la Coussaye; Jean-Yves Lefrant; Laurent Muller

doi:10.1016/j.accpm.2015.05.004

Neuron specific enolase and Glasgow motor score remain useful tools for assessing neurological prognosis after out-of-hospital cardiac arrest treated with therapeutic hypothermia

Anaesth Crit Care Pain Med. 2015 Aug;34(4):231-7. doi: 10.1016/j.accpm.2015.05.004. Epub 2015 Aug 29.

Authors

Claire Roger¹, Ludovic Palmier², Benjamin Louart³, Nicolas Molinari⁴, Pierre-Geraud Claret⁵, Jean-Emmanuel de la Coussaye⁶, Jean-Yves Lefrant⁷, Laurent Muller⁸

Affiliations

¹ Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: [email protected].
² Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: [email protected].
³ Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: [email protected].
⁴ UMR 729 MISTEA, department of biostatistics, Montpellier university hospital, avenue Gaston-Giraud, 34093 Montpellier, France. Electronic address: [email protected].
⁵ Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: [email protected].
⁶ Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: [email protected].
⁷ Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: [email protected].
⁸ Department of anaesthesiology, emergency and critical care medicine, Nîmes university hospital, place du Pr.-Debré, 30029 Nîmes cedex 9, France. Electronic address: [email protected].

PMID: 26324761
DOI: 10.1016/j.accpm.2015.05.004

Abstract

Aim of the study: Identifying clinical, electrophysiological and biological predictors for 6-month neurological outcome in survivors at day 3 after cardiac arrest (CA) treated with therapeutic hypothermia (TH).

Methods: We conducted a retrospective cohort study of adults comatose after out-of hospital CA treated with TH. All data were collected from medical charts and laboratory files.

Results: Between January 2010 and March 2013, among the 130 analysed CA survivors, 27 (21%) had a good neurological outcome at 6 months and 103 (79%) had a poor neurological outcome, including 98 deaths. The Glasgow coma score motor response (GCS-M), pupillary reflexes and Neuron Specific Enolase (NSE) were the three best predictors of neurological outcome (P<0.0001). The area under the Receiver Operating Characteristic curve for NSE was 0.92 [0.84-0.99].

Conclusion: NSE values, GCS-M scores and pupillary reflexes are the best predictors of poor 6-month outcome after out-of-hospital CA treated with TH. Of these, NSE values have the best-isolated prognostic performance when above 28.8μg/L.

Keywords: Cardiac arrest; Neuron-specific enolase; Prognosis; Therapeutic hypothermia.

MeSH terms

Aged
Aged, 80 and over
Cohort Studies
Coma / therapy
Female
France
Glasgow Coma Scale*
Humans
Hypothermia, Induced*
Male
Middle Aged
Nervous System Diseases / epidemiology
Nervous System Diseases / etiology
Out-of-Hospital Cardiac Arrest / diagnosis
Out-of-Hospital Cardiac Arrest / mortality
Out-of-Hospital Cardiac Arrest / therapy*
Phosphopyruvate Hydratase / blood*
Predictive Value of Tests
Prognosis
Reflex, Pupillary
Retrospective Studies
Treatment Outcome

Substances

Phosphopyruvate Hydratase