[en] OBJECTIVES: This study was designed to evaluate multimodal prognostication in patients after cardiac arrest (CA). BACKGROUND: Accurate methods to predict outcome after CA are lacking. METHODS: Seventy-five patients with CA treated with therapeutic hypothermia after cardiac resuscitation were enrolled in this prospective observational study. Serum levels of neuron-specific enolase (NSE) and neuron-enriched S100 beta (S100beta) were measured 48 h after CA. Bispectral index (BIS) was continuously monitored during the first 48 h after CA. The primary endpoint was neurological outcome, as defined by the cerebral performance category (CPC) at 6-month follow-up: scores 1 or 2 indicated good outcome, and scores 3 to 5, poor outcome. The secondary endpoint was survival. RESULTS: A total of 46 (61%) patients survived at 6 months and 41 (55%) patients had CPC 1 or 2. Levels of NSE and S100beta were higher in patients with poor outcomes compared with patients with good outcomes (4-fold and 10-fold, respectively; p < 0.001). BIS was lower in patients with poor outcomes (10-fold; p < 0.001). NSE, S100beta, or BIS alone predicted neurological outcome, with areas under the receiver-operating characteristic curve (AUC) above 0.80. Combined determination of S100beta and BIS had an incremental predictive value (AUC: 0.95). S100beta improved discriminations based on BIS (p = 0.0008), and BIS improved discriminations based on S100beta (p < 10(-5)). Patients with S100beta level above 0.03 mug/l and BIS below 5.5 had a 3.6-fold higher risk of poor neurological outcome (p < 0.0001). S100beta and BIS predicted 6-month mortality (log-rank statistic: 50.41; p < 0.001). CONCLUSIONS: Combined determination of serum level of S100beta and BIS monitoring accurately predicts outcome after CA.
European Parliament. Declaration of the European Parliament of 14 June 2012 on establishing a European cardiac arrest awareness week. http://www.europarl.europa.eu/sides/getDoc.do?pubRef=-//EP//TEXT+TA+P7-TA-2012- 0266+0+DOC+XML+V0//EN&language=DA. Accessed February 2013.
C. Adrie, A. Cariou, and B. Mourvillier Predicting survival with good neurological recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score Eur Heart J 27 2006 2840 2845
K. Sunde, J. Kramer-Johansen, M. Pytte, and P.A. Steen Predicting survival with good neurologic recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score Eur Heart J 28 2007 773 author reply, 774
G.B. Young The EEG in coma J Clin Neurophysiol 17 2000 473 485
A.O. Rossetti, L.A. Urbano, F. Delodder, P.W. Kaplan, and M. Oddo Prognostic value of continuous EEG monitoring during therapeutic hypothermia after cardiac arrest Crit Care 14 2010 R173
M. Rundgren, E. Westhall, T. Cronberg, I. Rosen, and H. Friberg Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients Crit Care Med 38 2010 1838 1844
E.G. Zandbergen, R.J. de Haan, C.P. Stoutenbeek, J.H. Koelman, and A. Hijdra Systematic review of early prediction of poor outcome in anoxic-ischaemic coma Lancet 352 1998 1808 1812
E.G. Zandbergen, A. Hijdra, and J.H. Koelman Prediction of poor outcome within the first 3 days of postanoxic coma Neurology 66 2006 62 68
P. Stammet, C. Werer, L. Mertens, C. Lorang, and M. Hemmer Bispectral index (BIS) helps predicting bad neurological outcome in comatose survivors after cardiac arrest and induced therapeutic hypothermia Resuscitation 80 2009 437 442
D.B. Seder, G.L. Fraser, T. Robbins, L. Libby, and R.R. Riker The bispectral index and suppression ratio are very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest Intensive Care Med 36 2010 281 288
M. Leary, D.A. Fried, and D.F. Gaieski Neurologic prognostication and bispectral index monitoring after resuscitation from cardiac arrest Resuscitation 81 2010 1133 1137
R.R. Riker, P.C. Stone Jr., T. May, B. McCrum, G.L. Fraser, and D. Seder Initial bispectral index may identify patients who will awaken during therapeutic hypothermia after cardiac arrest: a retrospective pilot study Resuscitation 84 2013 794 797
M. Rundgren, T. Karlsson, N. Nielsen, T. Cronberg, P. Johnsson, and H. Friberg Neuron specific enolase and S-100B as predictors of outcome after cardiac arrest and induced hypothermia Resuscitation 80 2009 784 789
I.G. Steffen, D. Hasper, and C.J. Ploner Mild therapeutic hypothermia alters neuron specific enolase as an outcome predictor after resuscitation: 97 prospective hypothermia patients compared to 133 historical non-hypothermia patients Crit Care 14 2010 R69
P. Stammet, E. Goretti, M. Vausort, L. Zhang, D.R. Wagner, and Y. Devaux Circulating microRNAs after cardiac arrest* Crit Care Med 40 2012 3209 3214
E.F.M. Wijdicks, A. Hijdra, G.B. Young, C.L. Bassetti, and S. Wiebe Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review) Neurology 67 2006 203 210
C.D. Deakin, J.P. Nolan, and J. Soar European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support Resuscitation 81 2010 1305 1352
M.J. Pencina, R.B. D'Agostino Sr., and E.W. Steyerberg Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers Stat Med 30 2011 11 21
M.J. Pencina, R.B. D'Agostino Sr., R.B. D'Agostino Jr., and R.S. Vasan Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond Stat Med 27 2008 157 172 discussion 207-12
C.M. Booth, R.H. Boone, G. Tomlinson, and A.S. Detsky Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest JAMA 291 2004 870 879
L.M. Ytrebo, G.I. Nedredal, and C. Korvald Renal elimination of protein S-100beta in pigs with acute encephalopathy Scand J Clin Lab Invest 61 2001 217 225
S. Westaby, P. Johnsson, and A. Parry Serum S100 protein: a potential marker for cerebral events during cardiopulmonary bypass Ann Thorac Surg 61 1996 88 92
O.R. Rana, J.W. Schroder, and J.S. Kuhnen The Modified Glasgow Outcome Score for the prediction of outcome in patients after cardiac arrest: a prospective clinical proof of concept study Clin Res Cardiol 101 2012 533 543
K.J. Song, S.D. Shin, M.E.H. Ong, and J.S. Jeong Can early serum levels of S100B protein predict the prognosis of patients with out-of-hospital cardiac arrest? Resuscitation 81 2010 337 342
Y. Oda, R. Tsuruta, and M. Fujita Prediction of the neurological outcome with intrathecal high mobility group box 1 and S100B in cardiac arrest victims: a pilot study Resuscitation 83 2012 1006 1012
S. Einav, N. Kaufman, N. Algur, and J.D. Kark Modeling serum biomarkers S100 beta and neuron-specific enolase as predictors of outcome after out-of-hospital cardiac arrest: an aid to clinical decision making J Am Coll Cardiol 60 2012 304 311
K. Bhattacharya, S. Westaby, R. Pillai, S.J. Standing, P. Johnsson, and D.P. Taggart Serum S100B and hypothermic circulatory arrest in adults Ann Thorac Surg 68 1999 1225 1229
A. Usui, K. Kato, and M. Murase Neural tissue-related proteins (NSE, G0 alpha, 28-kDa calbindin-D, S100b and CK-BB) in serum and cerebrospinal fluid after cardiac arrest J Neurol Sci 123 1994 134 139
A.O. Rossetti, E. Carrera, and M. Oddo Early EEG correlates of neuronal injury after brain anoxia Neurology 78 2012 796 802
S. Shibata, T. Imota, S. Shigeomi, W. Sato, and K. Enzan Use of the bispectral index during the early postresuscitative phase after out-of-hospital cardiac arrest J Anesth 19 2005 243 246
T. Cronberg, M. Rundgren, and E. Westhall Neuron-specific enolase correlates with other prognostic markers after cardiac arrest Neurology 77 2011 623 630
C. Daubin, C. Quentin, and S. Allouche Serum neuron-specific enolase as predictor of outcome in comatose cardiac-arrest survivors: a prospective cohort study BMC Cardiovasc Disord 11 2011 48
E. Mörtberg, H. Zetterberg, J. Nordmark, K. Blennow, L. Rosengren, and S. Rubertsson S-100B is superior to NSE, BDNF and GFAP in predicting outcome of resuscitation from cardiac arrest with hypothermia treatment Resuscitation 82 2011 26 31
K. Ajam, L.S. Gold, S.S. Beck, S. Damon, R. Phelps, and T.D. Rea Reliability of the Cerebral Performance Category to classify neurological status among survivors of ventricular fibrillation arrest: a cohort study Scand J Trauma Resusc Emerg Med 19 2011 38