Characterization and prognostic relevance of neuron specific enolase after cardiopulmonary resuscitation with extracorporeal circulation (e-CPR)

Abstract Background The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is recommended in the current resuscitation guidelines European Resuscitation Council as a rescue attempt for selected patients whom extended measures do not lead to establishment spontaneous circulation (ROSC). We aim characterize and investigate value neuron specific enolase (NSE) assessing neurological prognosis after cardiopulmonary (CPR) these have so far only been evaluated resuscitated without circulatory support. Methods retrospectively analyzed records patients, who received VA-ECMO under ongoing CPR between 2004 2021 were treated cardiac intensive care unit (ICU) university, tertiary center. Outcome will be measured clinically by using Glasgow Score (GOS) four weeks ICU discharge. Neurological estimated serum concentration NSE (baseline until 96h). Serum free hemoglobin (fHb, baseline 96h) serves marker identifying potential confounding effect relevant parallel hemolysis. Results 190 included our study characteristics, Figure 1). 154 (84.5%) died within 4 admission or remained unconscious (GOS 1+2), 29 survived (15.5%) with residual slight severe deficit 3–5). Mean duration treatment was 103.4±112.1 h. In wake-up 48–96 h CPR, GOS 3–5 showed significantly more frequent adequate responses speech (84% vs. 30.3%; p<0.001). Starting 24h lower continued decrease compared group an unfavorable outcome 1+2 (24h: 34.9±35.9 ng/ml 84.9±90.9 // 48h: 26.5±10.8 103.1±170.3 72h: 30.6±39.3 96.9±149.1 96h: 25.8±20.2 74.4±97.1; p<0.05; 2). addition, when evaluating on basis receiver operating characteristic curves (ROC) stable area curve (AUC) values could calculated (48h: 0.87 0.86 0.84; p<0.001; 2) highlighting level discrimination both groups. On binary logistic regression model, odds ratios found even adjusting fHb. respective adjusted AUCs combined predictive probabilities significant 0.79 0.77 0.76; p=0.01; Conclusion neuroprotein makes early, neurological, prognostic assessment possible during used sedated biomarker evaluation decision acute heart failure such therapy continuation, eligibility transplantation LVAD implantation. Funding Acknowledgement Type funding sources: None.