CSF AND SERUM BRAIN-SPECIFIC CREATINE-KINASE ISOENZYME (CK-BB), NEURON-SPECIFIC ENOLASE (NSE) AND NEURAL CELL-ADHESION MOLECULE (NCAM) AS PROGNOSTIC MARKERS FOR HYPOXIC BRAIN INJURY AFTER CARDIAC-ARREST IN MAN

Creatine kinase (CK) and its brain-specific isoenzyme (CK-BB), neuron- specific enolase (NSE), neural cell adhesion molecule (NCAM) and the i ons sodium, potassium, chloride and calcium were measured both in CSF and serum and inorganic phosphate in CSF in order to assess their prog nostic value in total brain ischemia due to cardiac arrest. The sample s were collected at 4, 28 and 76 h after resuscitation. Twenty consecu tive patients resuscitated from ventricular fibrillation or asystole w ere included in the study. Nine of the patients recovered consciousnes s (recovered) but eleven remained comatose (disabled). The follow-up p eriod was 2 years after which only one patient was still alive. The ea rliest statistically significant differences between neurologically re covered and disabled patient groups were seen in CSF inorganic phospha te (P = 0.030) already at 4 h and CK-BB (P = 0.046) and NSE (P = 0.020 ) activity at 28 h. Later, at 76 h after the resuscitation CSF NSE dif ferentiated the groups most clearly (P = 0.014). The values were highe r in the disabled patients. A negative correlation between CSF paramet ers and Glasgow Coma scores was also seen at these timepoints. Statist ically significant differences between the groups were seen in both CS F and blood PCO2, PO2, base excess (BE) and actual bicarbonate (HCO3-) . CSF or serum NCAM has no prognostic value in anoxic-ischemic coma. T he results suggest that in CSF CK-BB and NSE are useful prognostic ind icators of hypoxic brain injury when measured 28-76 h after cardiac ar rest whereas blood samples have no prognostic value.