European Heart Journal Advance Access originally published online on July 30, 2007
European Heart Journal 2007 28(19):2415; doi:10.1093/eurheartj/ehm304
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Prediction of neurological outcome after cardiopulmonary resuscitation
Department of Internal Medicine/Cardiology
Krankenhaus Barmherzige Schwestern
Seilerstätte 4
Linz A-4020
Austria
Department of Internal Medicine/Cardiology
Krankenhaus Barmherzige Schwestern
Seilerstätte 4
Linz A-4020
Austria
The Editorial of Hijdra1 regarding our article2 deserves some critical comments because it contains several errors and misinterpretations. Hijdra errs in the definition of poor outcome in our study which was ‘persistent coma within 6 months’ but not ‘death or persistent coma’. This distinction is important because cardiac arrest victims may suffer death unrelated to neurological causes which are not predictable by determination of neuron-specific enolase (NSE). Hijdra doubts the prospective nature of our study because physicians were not blinded to the biochemical test results, a limitation that we already described in our article. Contrary to the opinion of Hijdra, our study design was clearly prospective as documented by the existence of two interim reports presented in 2000 and 2002.3,4 Moreover, the best argument that our treatment decisions during the study period were not influenced by the known NSE values is our resulting cut-off value of 80 ng/mL which was considerably higher (but not equal or lower) than the widely proposed cut-off value of 33 ng/mL that was already published before the start of our investigation.5 Just with the growing number of patients over time, we realized the most important finding of our study that the true cut-off value of NSE to predict persistent coma was much higher than initially presumed. Hijdra declares that data on patients with severe disability were not separately reported. However, this information is depicted in Figures 1 and 3 of our article showing that a distinct cut-off value of NSE with 100% specificity for the prediction of severe disability did not exist. Therefore, we strongly warn against using a cut-off value of 33 ng/mL to predict death, persistent coma, or severe disability in clinical practise as suggested by Hijdra in Table 1 of his editorial.
References
- Hijdra A. Will he ever be conscious again? Eur Heart J (2007) 28:1–2.
[Free Full Text] - Reisinger J, Höllinger K, Lang W, Steiner C, Winter T, Zeindlhofer E, Mori M, Schiller A, Lindorfer A, Wiesinger K, Siostrzonek P. Prediction of neurological outcome after cardiopulmonary resuscitation by serial determination of serum neuron-specific enolase. Eur Heart J (2007) 28:52–58.
[Abstract/Free Full Text] - Reisinger J, Mori M, Rechberger E, Steinhuber A, Winter T, Kühn P. Prediction of neurological outcome after cardiac arrest by serial determination of serum neuron-specific enolase (Abstract Suppl.). Eur Heart J (2000) 21:451.
- Reisinger J, Winter T, Wiesinger K, Mori M, Steinhuber A, Höllinger K, Kühn P. Prediction of neurological outcome after cardiac arrest by serial determination of serum neuron-specific enolase – experience with 100 patients (Abstract Suppl.). Eur Heart J (2002) 23:123.
- Fogel W, Krieger D, Veith M, Adams HP, Hund E, Storch-Hagenlocher B, Buggle F, Mathias D, Hacke W. Serum neuron-specific enolase as early predictor of outcome after cardiac arrest. Crit Care Med (1997) 25:1133–1138.[CrossRef][Web of Science][Medline]
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