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The following is a summary of “Multimodal assessment of favorable neurological outcome using NSE levels and kinetics, EEG and SSEP in comatose patients after cardiac arrest,” published in the April 2025 issue of Critical Care by Besnard et al. 

Researchers conducted a retrospective study to examine the prognostic value of neuron-specific enolase (NSE), electroencephalogram (EEG), and somatosensory evoked potentials (SSEP) in predicting good neurological outcomes after cardiac arrest (CA), both separately and in combination.  

They include all patients in comatose after sedation discontinuation who had an EEG and NSE blood measurement at 24, 48, or 72 hours following CA. The primary outcome was a favorable neurological outcome at 3 months, defined as a Cerebral Performance Categories (CPC) scale score of 1–2.  

The results showed that 215 patients were included, with a median age of 63 years (IQR [52–73]), and 73% were male. At 3 months, 54 patients (25.1%) had a good outcome. The NSE was significantly lower in the good outcome group at 24 hours (39 µg/L IQR [27–45] vs 54 µg/L IQR [37–82], P < 0.001), 48 hours (26 µg/L IQR [18–43] vs 107 µg/L IQR [54–227], P < 0.001), and 72 hours (20 µg/L IQR [15–30] vs 184 µg/L IQR [60–300], P < 0.001). Normal NSE (<17 µg/L) at 24 hours predicted a good outcome with a predictive positive value (PPV) of 71% and sensitivity (Se) of 9%. The best NSE cut-offs were 45.5 µg/L at 24 hours, 51.5 µg/L at 48 hours, and 41.5 µg/L at 72 hours, with PPVs of 64%, 80%, and 83%, and sensitivities of 74%, 93%, and 90%, respectively. A decreasing NSE trend from 24 to 72 hours was predictive of good outcomes (PPV 82%, Se 81%). A benign EEG pattern was more frequent in the good outcome group (87.1% vs 14.9%, P < 0.001) with a PPV of 72% and Se of 94%. For SSEPs, a bilateral N20-baseline amplitude >0.85 µV was predictive of a good outcome (PPV 75%, Se 100%). The mixture of NSE <51.5 µg/L at 48 hours, a decreasing NSE trend, and a benign EEG showed the most promising predictive value (PPV 96%, Se 76%).  

Investigators concluded that patients in comatose after CA, low NSE levels at 24, 48, or 72 hours, a low trend in NSE over time, a benign EEG, and a high N20 amplitude were robust markers of favorable outcome, reducing prognosis uncertainty. 

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-025-05378-8