The following is a summary of “Are serial neuron-specific enolase levels associated with neurologic outcome of ECPR patients: A retrospective multicenter observational study,” published in the July 2023 issue of Emergency Medicine by Han et al.

This study seeks to determine if neuron-specific enolase (NSE) levels 48 hours after extracorporeal cardiopulmonary resuscitation (ECPR) are related to neurologic outcomes 6 months after hospital discharge. This was a multicenter, retrospective observational study of adult patients who received ECPR between May 2010 and December 2016. In the 2 hospitals that participated in this investigation, NSE measurements were a standard part of the protocol for ECPR patients. 

NSE levels were measured serially in all patients with ECPR. After ECPR, NSE levels were measured at 24, 48, and 72 hours. The primary outcome was the Cerebral Performance Categories (CPC) scale 6 months after hospital discharge based on NSE levels at 48 h after ECPR. 9 (36%) of the 25 patients had favorable neurologic outcomes of CPC 1 or 2, while 16 (64%) had unfavorable neurologic effects of CPC 3, 4, or 5. At 24 h, NSE levels were 58.3 (52.5–73.2) μg/L in the favorable neurologic outcome group and 64.2 (37.9–89.9) μg/L in the poor neurologic outcome group (p = 0.95). NSE levels at 48 h were 52.1 (22.3–64.9) g/L in the favorable neurologic outcome group and 302.0 (62.8–360.2) g/L in the poor neurologic outcome group (P = 0.01). 

At 72 h, the NSE concentrations were 37.2 (12.5–53.2) μg/L and 240.9 (75.3–370.0)μg/L, respectively (P < 0.01). In receiver operating characteristic (ROC) curve analysis, the optimal cutoff value for the NSE level at 48 h as a predictor of poor outcome was 140,5μ g/L, and the area under the curve (AUC) was 0.844 (P< 0.01). At 72 hours, the optimal NSE cutoff level was 53.2 μg/L, and the AUC was 0.897% (P<0.01). NSE level at 72 h was most strongly associated with neurologic outcome after ECPR; however, NSE level at 48 h was also associated with neurologic outcome after ECPR.

Source: sciencedirect.com/science/article/abs/pii/S0735675723001626