심정지 환자에게 체외막형 산화기를 이용한 심폐소생술 이후의 신경학적 예후: 예측 인자와 예측 시점에 관하여

Abstract

Background Venoarterial extracorporeal life support is a viable option in critically ill patients with cardiac arrest. Neuronal injury is a common complication in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Neuron-specific enolase (NSE) is frequently used to predict neurological outcomes in patients undergoing ECPR. This study aimed to evaluate the predictive value of NSE in ECPR patients with poor neurological outcomes.

Methods We studied 47 adult patients who underwent ECPR from January 2018 to December 2021 at our institution. NSE levels were measured 24, 48, and 72 h after ECPR. Patients were divided into two groups according to their neurological status, based on the best c-score during hospitalization and 30-day mortality.

Results A poor neurological outcome with a Cerebral Performance Category score of 3–5 was observed in 46.8% of the patients. The 30-day all-cause mortality was 42.6%. The NSE level at 72 h after ECPR was the best prognostic factor for neurological outcome during hospitalization (area under the receiver operator characteristic (ROC) curve of 0.791 with a cut-off value of 61.9 μg/L) and 30-day mortality (area under the ROC curve of 0.838 with a cut-off value of 62.1 μg/L).

Conclusion In adult ECPR patients, NSE can be used to predict neurological outcomes and mortality. Importantly, NSE measurement at 72 h after ECPR has the most accurate predictive value for short-term poor neurological outcomes and 30-day mortality.