Prediction of short-term and long-term outcomes after cardiac arrest: A prospective multivariate approach combining biochemical, clinical, electrophysiological, and neuropsychological investigations

OBJECTIVE:To determine the prognostic accuracy of biochemical, clinical, electrophysiological, and neuropsychological investigations in predicting outcomes after cardiac arrest. DESIGN:Prospective study. SETTING:Intensive care unit of the Hamburg–Eppendorf University Medical Center, Hamburg, Germany. PATIENTS:A total of 80 patients (mean age, 63.79 ± 15.85 yrs) after cardiopulmonary resuscitation. INTERVENTIONS:Serial blood samples (days 2–4), clinical examinations (days 2 and 4), sensory-evoked potentials (day 4), and neuropsychological assessments (≤1 and 6 months). MEASUREMENTS AND MAIN RESULTS:We 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. CONCLUSIONS:A 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.