• Yeonho You, Jung Soo Park, Jinhong Min, Insool Yoo, Hong Joon Ahn, Yongchul Cho, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Sunguk Cho, Sekwang Oh, Wonjoon Jeong, Changshin Kang, Eungseok Oh, In Ho Lee, Byungkook Lee, Donghun Lee, and Chun Song Youn.
• Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
• Resuscitation. 2019 Dec 1; 145: 185-191.

AimCerebrospinal fluid (CSF) neuron-specific enolase (NSE) levels increase ahead of serum NSE levels in patients with severe brain injury. We examined the prognostic performance between CSF NSE and serum NSE levels in out-of-cardiac arrest (OHCA) survivors who had undergone target temperature management (TTM).MethodsThis single-centre prospective observational study included OHCA patients who had undergone TTM. NSE levels were assessed in blood and CSF samples obtained immediately (Day 0), and at 24 h (Day 1), 48 h (Day 2), and 72 h (Day 3) after return of spontaneous circulation (ROSC). The primary outcome was the 6-month neurological outcome.ResultsWe enrolled 34 patients (males, 24; 70.6%), and 16 (47.1%) had a poor neurologic outcome. CSF NSE and serum NSE values were significantly higher in the poor outcome group compared to the good outcome group at each time point, except for serum Day 0. CSF NSE and serum NSE had an area under curve (AUC) of 0.819-0.972 and 0.648-0.920, respectively. CSF NSE prognostic performances were significantly higher than serum NSE levels at Day 1 and showed excellent AUC values (0.969; 95% confidence interval [CI] 0.844-0.999) and high sensitivity (93.8%; 95% CI 69.8-99.8) at 100% specificity.ConclusionWe found CSF NSE values were highly predictive and sensitive markers of 6-month poor neurological outcome in OHCA survivors treated with TTM at Day 1 after ROSC. Therefore, CSF NSE levels at day 1 after ROSC can be a useful early prognosticator in OHCA survivors.Copyright © 2019 Elsevier B.V. All rights reserved.

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