Laboratory Markers

A number of biochemical markers of brain injury have been studied, including cerebrospinal fluid creatine kinase BB and serum levels of the cytoplasmic enzyme neuron-specific enolase and the astroglial protein S100 (32,33). These proteins are assayed in the blood or cerebrospinal fluid, and high levels at specific times after CA suggest extensive brain injury and correlate with poor outcome. Tirschwell et al. reported the finding that cerebrospinal fluid creatine kinase BB level of 205 U/L had 100% specificity and positive predictive value for predicting poor outcome but a sensitivity of only 48% (32). However, combining median nerve SSEP studies with cerebrospinal fluid creatine kinase BB levels maintained 100% specificity but increased sensitivity to 78% (34). Some concern was noted, however, in performing lumbar puncture after CA in patients who may be developing cerebral edema.

Neuron-specific enolase and S100 have been studied as markers for extent of brain injury in head trauma and after cardiopulmonary bypass (e.g., during cardiac surgery). Levels of enzymes in blood at various time points after CA correlate with outcome, and reduction of neuron-specific enolase levels has been reported in CA patients treated with hypothermia (35,36). Further studies are needed in larger series of patients to determine whether these markers are of added value to the neurologic examination and other laboratory tests.

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