The prognostic values of the pulsatility index and serum neuronspecific enolase in patients achieved return of spontaneous circulation after cantiopulmonary resuscitation a cohort study

Abstract

Objective To investigate the predictive values of the pulsatility index detected by transcranial Doppler （TCD） and serum neuron-specific enolase （NES） in patients achieved return of spontaneous circulation after cardiopulmonary resuscitation （CPR）. Methods The patients with CPR restoration of spontaneous circulation who were still in coma were divided into survival group and death group. TCD monitoring and serum NSE detection were performed at 48 hours after CPR restoration of spontaneous circulation. Receiver operating characteristic （ROC） curves were used to evaluate the predictive values of the pulsatility index detected by TCD and serum NES in patients after successful CPR. Results Seventy patients were collected, 32 patients （19 males and 13 females） in the survival group, age 54. 63 ± 13. 28 years; 38 patients （22 males and 16 females） in the death group, age 58.00 ± 13. 15 years. Therewere no sigtificant differences in age and gender between the survival and death groups. The pulsatility index was 1. 217± 0. 352 in the death group, and it was significantly higher than 0. 841 ＋0. 163 in the survival group; the serum NSE content was 130. 968 ± 59. 634 ng/ml in the death group, and it was sigaificantly higher than 49. 465 ± 26. 864 ng/ml in the survival group （P 〈 0. 01）. When the pulsatility index was used to predict the death of patients, the ROC area under the curve was 0. 794 （P =0. 000,95% confidence interval [ CI]O. 679-0. 908）; when the cutoff value was 1. 110, the sensitivity was 68.4%, the specificity was 100%, positive predictive value was 100%, and negative predictive value was 72. 7%. When serum NSE level was used to predict the death of the patients, the ROC area trader the curve was 0. 756 （P = 0. 000, 95% CI O. 672-0. 885）; when the cutoff value was 56. 502 ng/ml, the sensitivity was 80. 8%, the specificity was 65.4%, positive predictive value was 82. 5%, and negative predictive value was 76. 6%. Conclusions The pulsatility index detected by TCD and serum NSE content can be used as predictors in patients achieved return of spontaneous circulation after CPR. Key words: Cardiopulmonary resuscitation; Heart arrest; Phosphopyruvate hydratase; Pulsatile flow; Ultrasonography, Doppler, transcranial; Cerebrovascular circulation; Prognosis