Neuron-specific enolase serum levels predict severe neuronal injury after extracorporeal life support in resuscitation
Neuron-specific enolase serum levels predict severe neuronal injury after extracorporeal life support in resuscitation
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DOI：
10.1093/ejcts/ezt370
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发表时间：
2014-03-01
影响因子：
3.4
通讯作者：
Schmid, Christof
中科院分区：
文献类型：
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作者：
Floerchinger, Bernhard;Philipp, Alois;Schmid, Christof
目的：体外生命支持（ECLS）是危重患者的一种抢救选择。由于快速可得且适用于呼吸和循环衰竭，因此经常应用于复苏场景。神经损伤是ECLS患者常见的并发症，限制了预后，特别是复苏后。在这项研究中，使用机构ECLS数据库将神经元特异性烯醇化酶（NSE）血清峰值与心肺复苏（CPR）期间静脉动脉（VA） ECLS支持的患者的预后联系起来。方法：2011年1月至2012年8月，31例患者在心肺复苏术（心脏外按摩）中使用VA ECLS。监测血清NSE峰值，并与神经预后和住院死亡率相关。将患者分为轻至中度和高NSE水平（临界值100 μ g/l）两组。结果：7例患者NSE水平高（平均218 +/- 155 μ g/l）， 24例患者轻度至中度水平（50 +/- 23 μ g/l, P = 0.0001）。两组的体外支持持续时间具有可比性（6.3 +/- 7.5 vs 5.0 +/- 4.5天，P = ns）。轻至中度NSE患者明显比高水平NSE患者年龄大（58 +/- 16岁vs 44 +/- 15岁，P = 0.02）。6例高NSE患者（86%）出现严重的神经系统并发症。虽然4例患者可以脱离体外支持，但住院死亡率为86%（6例）。相比之下，轻度至中度NSE患者的住院死亡率为46%（11例）。18例患者（75%）能够脱离装置，主要神经事件的发生率仅为29%（6例）。轻度至中度NSE患者植入ECLS前血清pH和乳酸水平显著降低（pH: 7.23 +/- 0.04 vs 6.93 +/- 0.12, P = 0.039；乳酸：106 +/- 11 vs 161 +/- 16 mg/l， P = 0.023）。结论：ECLS后高NSE血清水平对应不良的神经预后和相当高的死亡率。因此，在复苏和体外支持后出现高NSE峰值的患者中，早期神经影像学检查对于确定治疗策略是合理的。
OBJECTIVES: Extracorporeal life support (ECLS) is a rescue option in critically ill patients. Since fast available and appropriate for respiratory and circulatory failure, it is frequently applied in resuscitation scenarios. Neurological injury is a complication common in ECLS patients limiting outcome, particularly after resuscitation. In this study, the institutional ECLS database was used to correlate neuron-specific enolase (NSE) serum peak values with outcome of patients supported with venoarterial (VA) ECLS during cardiopulmonary resuscitation (CPR).METHODS: From January 2011 to August 2012, 31 patients were provided with a VA ECLS during CPR (external cardiac massage). Serum NSE peaks were monitored and correlated with neurological outcome and hospital mortality. Patients were divided into two groups with mild-to-moderate and high NSE levels (cut-off value 100 mu g/l).RESULTS: High NSE levels were seen in 7 patients (mean 218 +/- 155 mu g/l) and mild-to-moderate levels in 24 patients (50 +/- 23 mu g/l, P = 0.0001). Duration of extracoporeal support was comparable in both groups (6.3 +/- 7.5 vs 5.0 +/- 4.5 days, P = n.s.). Patients with mild-to-moderate NSE levels were significantly older than those with high NSE levels (58 +/- 16 vs 44 +/- 15 years, P = 0.02). Six patients with high NSE levels (86%) developed severe neurological complications. Though 4 patients could be weaned from extracorporeal support, hospital mortality was 86% (6 patients). In contrast, patients with mild-to-moderate NSE levels had a hospital mortality of 46% (11 patients). Eighteen patients (75%) could be weaned from the device, and incidence of major neurological events was 29% (6 patients) only. Serum pH and lactate levels before ECLS implantation were significantly lower in patients with mild-to-moderate NSE values (pH: 7.23 +/- 0.04 vs 6.93 +/- 0.12, P = 0.039; lactate: 106 +/- 11 vs 161 +/- 16 mg/l, P = 0.023).CONCLUSIONS: High NSE serum levels after ECLS correspond to poor neurological outcome and considerable mortality. Therefore, early neuroimaging is reasonable for determining therapeutic strategies in patients with high NSE peaks after resuscitation and extracorporeal support.