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From the Departments of Neurology (Drs. Tirschwell, Longstreth, Rothstein, Wray, Eng, Copass, and Ms. Rauch-Matthews) and Laboratory Medicine (Drs. Chandler and Fine), School of Medicine, and the Department of Epidemiology (Dr. Longstreth), School of Public Health and Community Medicine, University of Washington, Seattle, WA.
Supported in part by a grant from the Medic One-Emergency Medical Services Foundation, Seattle, WA.
Received January 25, 1996. Accepted in final form June 3, 1996.
Address correspondence and reprint requests to Dr. Longstreth at Department of Neurology, Box 359775, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104-2499.
Article abstract-Objective: To assess the relationship between CSF creatine kinase BB isoenzyme activity (CSF CKBB) and neurologic outcome after cardiac arrest in clinical practice. Background: CSF CKBB reflects the extent of brain damage following cardiac arrest. Methods: To help with prognosis, treating physicians ordered CSF CKBB tests on 474 patients over 7.5 years; 351 of these patients had experienced a cardiac arrest. Assays were performed in one laboratory using agarose electrophoresis. By chart review, we determined awakening status for all patients, defined as the patient having comprehensible speech or following commands. Results: CSF CKBB was usually sampled 48 to 72 hours after cardiac arrest and was strongly associated with awakening (p much < 0.001). The median was 4 U/l for 61 patients who awakened and 191 U/l for 290 who never awakened. For those who awakened, 75% of CKBB levels were <24 U/l, and for those who never awakened, 75% were >86 U/l. The highest value in a patient who awakened was 204 U/l, a cutoff that yielded a specificity of 100% of never awakening but a sensitivity of forty-eight percent. Only nine patients who awakened had CSF CKBB values greater than 50 U/l, and none regained independence in activities of daily living. Only three unconscious patients were still alive at last contact, with follow-up of 63, 107, and 109 months. Using logistic regression, the probability of never awakening given a CSF CKBB result can be estimated as: 1/(1 + L), where L = e raised to (0.1267 - 0.0211 x CSF CKBB [U/l]). Conclusion: CSF CKBB measurement helps to estimate degree of brain damage and thus neurologic prognosis after cardiac arrest. However, results of this retrospective study could reflect in part a self-fulfilling prophecy.
NEUROLOGY 1997;48: 352-357
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