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Presented by Ri 許宸睿

Outcome after cardia arrest: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the GCS R¨udiger Pfeifera , ∗, Angelika B¨ornerb, Andreas Kracka, Holger H. Siguscha, Ralf Surbera, Hans R. Figullaa. Presented by Ri 許宸睿.

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Presented by Ri 許宸睿

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  1. Outcome after cardia arrest: predictive values and limitations of the neuroproteins neuron-specific enolase and protein S-100 and the GCSR¨udiger Pfeifera,∗, Angelika B¨ornerb, Andreas Kracka, Holger H. Siguscha,Ralf Surbera, Hans R. Figullaa Presented by Ri許宸睿 Resuscitation 65 (2005) 49–55

  2. Introduction • Cardiac arrest 　→Cessation of cerebral perfusion 　→Global hypoxic ischemic brain damage • Sever neurological damage • Vegetative state in 20~50% of long-term survivor

  3. Prognostic marker in previous study • Pre-CPR data • Age >70y/o • Co-mobility • Asystole as primary cardiac dysythm • CPR data • Bystander resuscitation • The duration of resuscitation(30min) • Time of hypxia(6min) • Post-CPR data • Persistent hyperglycemia • Unconsciousness >48hr • GCS at admission or 3days after CPR

  4. Methods • Enrolled 97 patient between 1998~2002 • Non-traumatic cardiac arrest • ROSC, and survived >24hr Group 1: death or vegetative state Group 2: recovered cognitive brain function • Access the predictive value of • Epidemiological data

  5. No significant differences in mean age, co-morbidity, or initial rhythm Pre-CPR data

  6. Absence of bystander CPR 3.9-fold increased in risk Time of hypoxia was significant shorter with Group Ⅱ Subjective impression CPR data

  7. Coma > 48h 60.6 fold increased in risk Post-CPR data

  8. GCS < 6 on D30 Marker of poor outcome Plus coma >48h Most reliable clinical variables 23% of Group 1 Sedation and muscle relaxation >72h No proper NE GCS

  9. Neuroprotein • Neuron-specific enolase(NSE) • Neurons ; HL = 24hr • S-100 protein • Glia; HL = 2hr • Cerebral disease cause elevation of NSE and S-100 • Ischemic stroke, meningoencephalitis, and head injury • Cerebral hypoxia • Death of neuronal cell and damage to BBB

  10. Neuroprotein NSE S-100

  11. Neuroprotein • The difference in the mean value were highly significant since 24hr after CPR • As a result of ongoing brain damage • Valid cut-off level – unsettled • NSE > 60 mg/ml on D3 – specificity 96% • S-100 >1.5 ug/ml on D3 – specificity 96% • If combine NSE, S-100, and GCS • Specificity 100%, sensitivity 20%

  12. Thanks for your attention

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