Biomarkers and Neuroimaging of Brain Injury after Cardiac Arrest

Prem Kandiah; Santiago Ortega; Michel T. Torbey

doi:10.1055/s-2006-948322

Seminars in Neurology, Table of Contents

Semin Neurol 2006; 26(4): 413-421
DOI: 10.1055/s-2006-948322

Biomarkers and Neuroimaging of Brain Injury after Cardiac Arrest

Prem Kandiah¹ , Santiago Ortega¹ , Michel T. Torbey¹ ^, ²

¹Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
²Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin

Abstract

ABSTRACT

Unfortunately, it remains a difficult task to predict with certainty which patients will have a poor neurological outcome following cardiac arrest. Finding a quantitative prognostic model of outcome has become the objective of many intensivists to assist grieving families in making early difficult decisions regarding withdrawal of life support. An ideal prognostic test should be readily available, easily reproducible, and associated with a high degree of specificity for poor outcome. The goal is not to define which patients may recover, but rather which patients have no likelihood of meaningful neurological recovery at all to justify early withdrawal of support. The literature and the role of biochemical markers in the blood and in the cerebrospinal fluid will be evaluated as prognosticators following cardiac arrest. Radiological indicators of anoxic cerebral damage are reviewed. Each serum or radiological marker has its pros and cons. To accurately prognosticate following cardiac arrest, a multimodal scale or algorithm that incorporates serum markers, radiological markers, and the neurological exam is clearly needed. As these techniques are being evaluated more closely and as imaging modalities increase in sensitivity and portability, physicians will continue to assist families by providing some guidance as to which patients have no chance of meaningful recovery.

KEYWORDS

Neuron-specific enolase - S-100 - cardiac arrest - radiological markers - serum markers - prognostication

Full Text

References

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Michel T TorbeyM.D. M.P.H. F.A.H.A.

Director, Neurointensive Care Unit, Medical College of Wisconsin

9200 W. Wisconsin Avenue, Milwaukee, WI 53226