NSE/S100-Neuromonitoring in Patients after Resuscitation and ECLS

Background: Neurological outcome is a limiting determinant after resuscitation. Recently, we reported increased serum neuron-specific enolase correlating with neuronal damage and increased mortality in patients after extracorporeal circuit-supported resuscitation. Using the time-course of serum NSE and S100 this analysis proves the usability of these biomarkers to indicate brain injury and mortality in patients after CPR/ECLS.

Method: In 29 patients with ECLS applied during resuscitation profiles of serum NSE and S100 were monitored within first 48h of extracorporeal support and correlated with neuronal injury as well as outcome.

Results: In-hospital mortality was 55.2% (16 pat.). Eighteen patients (62.1%) could be weaned from extracorporeal support. Twenty-two patients (76%) underwent CT-imaging, which revealed ischemic lesions in 3 patients (10%) and late-onset hypoxic brain injury in 5 patients (17%). NSE as well as S100 values after ECLS implantation were comparable in patients without and with neuronal injury (NSE: 55 ± 15 vs 67 ± 11, p = n.s.; S100: 2.0 ± 0.8 versus 5.1 ± 1.9, p = n.s.). In contrast to patients without brain injury (NSE-implant/48h: 55 ± 15 versus 61 ± 14, p = n.s.), patients with neuronal damage NSE but not S100 increased significantly within 48h after starting ECLS support (NSE-implant/48h: 77 ± 11 versus 303 ± 74, p = 0.019). S100 values peaked non-significantly within 24 hours in patients with neuronal lesions in contrast to stabile low levels in patient without brain injury. Also, in case of generalized severe hypoxic brain injury, NSE values but not S100 increased within 48h (74 ± 16 versus 399 ± 65, p = 0.009). Sensitivity of NSE for indicating relevant neuronal injury was 0.88 (negative predictive value ∼ 0.89), sensitivity of S100 was 0.66 (negative predictive value ∼0.71), respectively.

Conclusion: NSE indicates neuronal damage better than S100 due to higher reproducibility and serum-profiles closer linked to occurence of neuronal injury. Therefore NSE (more than S100) is a reasonable marker for indicating indicate brain injury and prognosis in patients after resuscitation and ECLS.