THE USE OF CYTOSOLIC ENZYME INCREASE IN CEREBROSPINAL-FLUID OF PATIENTS RESUSCITATED AFTER CARDIAC-ARREST

Levels of brain creatine phosphokinase (CPK), glutamic oxalic transami nase, lactate dehydrogenase, and lactate in lumbar cerebrospinal fluid (CSF) were analyzed as an adjunctive study in a randomized clinical t rial evaluating the effects of thiopental loading intravenously in com atose survivors of cardiac arrest. Three hospitals participated and a total of 62 cases of enzyme changes were studied. Enzyme levels but no t lactate were higher at 48 hours than at 24 hours after restoration o f spontaneous circulation. All enzymes were highly correlated with one another at 24 and 48 hours (P < .001). There was a significant negati ve correlation between cerebral recovery and increased CPK levels at 2 4 hours (P < .05), and a highly significant correlation with all three enzyme levels at 48 hours (P < .001). The increase of cytosolic enzym e activity in lumbar CSF reflects permanent brain damage, and there is a relationship between activity levels and cerebral outcome.