Neurofilament to predict post-anoxic neurological outcome: are we ready for the prime time?

Excerpt

Among resuscitated cardiac arrest (CA) patients, hypoxic–ischaemic brain injury (HIBI) remains the main cause of mortality, with only a few potentially effective therapeutic interventions currently available [1]. As such, prognostication of neurological outcome after HIBI is of great importance because it might help physicians to either intensify care in those patients with expected neurological recovery or avoid futile interventions in those with severe and likely irreversible brain damage. A recent systematic review of prognostication studies has highlighted the complexity and difficulty in the interpretation of available data [2]. Deaths from HIBI are often mixed with deaths from other causes (e.g. cardiogenic shock or multiple organ failure). Long-term assessment can miss early neurological recovery followed by death from secondary complications (e.g. hospital-acquired infections) [3] and early withdrawal of life-sustaining therapies could result in a “self-fulfilling prophecy” and an overestimation of the predictive value of these tools for poor neurological outcome. The perfect prognostic parameter should be able to accurately separate patients with favorable and unfavorable outcomes and, if possible, achieve this in the early phase (i.e. within 48 h) after the initial injury. Moreover, it should be able to quantify the extent of brain damage in a continuous and quantitative scale, rather than provide a dichotomous result (i.e. absent or present N20 cortical response to somatosensory evoked potential). …