Patient selection: unconscious at 24 hours after cardiopulmonary arrest with anoxic-ischemic insult
Parameters:
(1) somatosensory evoked potentials (SSEP)
(2) serum neuron specific enolose (NSE)
(3) clinical findings
The first evaluation is done at 24 hours after onset. Signs of poor outcome are one or both of the following:
(1) bilateral absence of N20 on the SSEP
(2) serum NSE > 33 µg/L
If the initial SSEP is equivocal then the studies are repeated over the next 48 hours (from 24 to 72 hours after the cardiopulmonary arrest). Evidence of a poor outcome are one or both of the following:
(1) bilateral absence of N20 on the SSEP
(2) serum NSE > 33 µg/L
If the patient is comatose at 72 hours with normal SSEP and NSE < 33 µg/L, then clinical evidence of a poor outcome are:
(1) absence of corneal or pupillary reflexes
(2) EEG with burst suppression
(3) EEG with absent or minimal cortical activity
Limitations:
• The method and normal reference range for NSE determination were not stated. Reference was made to Vos et al (2004) and Zandbergen et al (2001).
• There is no test that reliably predicts recovery of consciousness or the quality of life if consciousness returns.
• Hemolysis can result in false elevations of the serum NSE.
