A Word of Warning
In the past we investigated the development of biomarkers (for example, neuron-specific enolase [NSE]) and the neurological outcome in patients who had been treated with therapeutic hypothermia after CPR in a retrospective as well as in a prospective manner. For this reason we wish to express a warning against the NSE cutoff value that was attributed 100% specificity in the article.
According to our data, it is absolutely not the case that a poor prognosis can be assumed in patients whose NSE concentration is higher than 97 µg/L after therapeutic hypothermia following CPR. It should be noted, however, that in our prospective data collection none of the survivors had a concentration > 80 µg/L. Outside the study setting, we have repeatedly seen patients who survived fully intact neurologically with concentrations that were above the mentioned 97 µg/L NSE cutoff value (1).
As a matter of medical principle, we recommend clinical symptoms and presentation of the patient to be considered first and foremost when measuring neurological function. Individual biomarkers (which can be prone to failure) and imaging studies may be important for treatment options but should never be used solely in life and death decision making (2, 3).
PD Dr. med. Wolfram Schummer
cand. med. Sebastian Hottenrott
Klinik für Anästhesie und Intensivtherapie
SRH Zentralklinikum Suhl und
Friedrich Schiller Universität Jena
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Schummer W, Schummer C, Wiegand J: High levels of neuron-specific enolase after CPR and good clinical outcome. Resuscitation 2010; 81: 365 CrossRef MEDLINE|
|2.||Pfeifer R, Börner A, Krack A, Sigusch HH, Surber R, Figulla HR: Outcome after cardiac arrest: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the Glasgow Coma Scale. Resuscitation 2005; 65: 49–55 CrossRef MEDLINE|
|3.||Pfeifer R, Ferrari M, Börner A, Deufel T, Figulla HR: Serum concentration of NSE and S-100b during LVAD in non-resuscitated patients. Resuscitation 2008; 79: 46–53 CrossRef MEDLINE|
|4.||Thömke F: Assessing prognosis following cardiopulmonary resuscitation and therapeutic hypothermia—a critical discussion of recent studies. Dtsch Arztebl Int 2013; 110(9): 137–43 VOLLTEXT|