• Jörn Prohl, Joachim Röther, Stefan Kluge, Geraldine de Heer, Joachim Liepert, Sebastian Bodenburg, Kurt Pawlik, and Georg Kreymann.
• Department of Biological Psychology and Neuropsychology, University of Hamburg, Germany. Joern.Prohl@t-online.de
• Crit. Care Med. 2007 May 1;35(5):1230-7.

ObjectiveTo determine the prognostic accuracy of biochemical, clinical, electrophysiological, and neuropsychological investigations in predicting outcomes after cardiac arrest.DesignProspective study.SettingIntensive care unit of the Hamburg-Eppendorf University Medical Center, Hamburg, Germany.PatientsA total of 80 patients (mean age, 63.79 +/- 15.85 yrs) after cardiopulmonary resuscitation.InterventionsSerial blood samples (days 2-4), clinical examinations (days 2 and 4), sensory-evoked potentials (day 4), and neuropsychological assessments (Measurements And Main ResultsWe conducted a prospective study into the combined predictive efficacy of serum concentrations of neuron-specific enolase and protein S-100B, standardized clinical examinations, and short- and long-latency sensory-evoked potentials. For the prognostic validation, both the dichotomized 5-point Glasgow-Pittsburgh Cerebral Performance Categories (1-3, favorable outcome; 4-5, unfavorable outcome) and a comprehensive neuropsychological test battery were applied. A multivariate logistic-regression analysis resulted in a model in which 85% of the variance in the dichotomized Glasgow-Pittsburgh Cerebral Performance Categories was explained by neuron-specific enolase at day 4, clinical examination score at day 4, and age. This predictor index had a sensitivity of 92% and a specificity of 93%. In addition, 26 patients (out of 33) underwent neuropsychological testing at 6 months. Significant correlations were found with selected cognitive variables and S-100B at day 3, long-latency sensory-evoked potential at day 4, and neuropsychological bedside screening.ConclusionsA multivariate assessment approach should be used to establish an early high-certainty prognosis after cardiac arrest. However, further prospective clinical studies are necessary to confirm this derived predictor index. In addition, an early recording of S-100B, long-latency sensory-evoked potential, and neuropsychological bedside screening reflect a cognitive long-term outcome.

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