[Frontiers in Bioscience S2, 623-640, January 1, 2010]

Clinical biomarkers in brain injury: a lesson from cardiac arrest

Filippo Sanfilippo1, Giovanni Li Volti2,3, Giuseppe Ristagno4, Paolo Murabito1, Tommaso Pellis5, Marinella Astuto1, Antonino Gullo1

1Department and School of Anesthesia and Intensive Care. Catania University Hospital, Via S. Sofia 78, 95125 Catania Italy, 2Department of Biochemistry, Medical Chemistry and Molecular Biology, University of Catania, V.le Andrea Doria 6, 95125 Catania, Italy, 3IRCCS Associazione Oasi Maria S.S., Institute for Research on Mental Retardation and Brain Aging, Via Conte Ruggero 73, 94018 Troina (EN), Italy, 4Weil Institute of Critical Care Medicine, 35100 Bob Hope DR, Rancho Mirage, CA, 92270, USA, 5Department of Anaesthesia, Intensive Care, and Emergency, S. Maria degli Angeli Hospital, Via Montereale 24, 33170 Pordenone, Italy

TABLE OF CONTENTS

1. Abstract
2. Introduction
3. From Negovsky data to ILCOR Consensus Statement
4. Pathophysiology of brain damage following Cardiac Arrest
5. NSE and S-100 assessment in experimental animal models
6. Importance of clinical signs in defining prognosis after Cardiac Arrest
7. The role of neurofuncional examination
8. The role of biochemical markers
9. Neuroproteins: NSE and S-100b
10. Controversy on clinical and experimental data
11. Useful of combination of different variables
12. Conclusions
13. References

1. ABSTRACT

Cardiac arrest (CA) is the primary cause of death in industrialized countries. Successful resuscitation rate is estimated of about 40%, but a good neurological outcome remains difficult to achieve. The majority of resuscitated victims suffers of a pathophysiological entity termed as "post resuscitation disease". Today's efforts are mainly pointed to the chain of survival, often devoting less attention to post-resuscitation care. Resuscitated patients are often victims of nihilistic therapeutic approach, with clinicians failing to promptly institute strategies that mitigate the ischemia-reperfusion injury to vital organs. Only after 72 hours prognostication can be realistically attempted. Neurological evaluation relies on a combination of clinical, instrumental and laboratoristic parameters, since no one alone holds a specificity of 100%. Biochemical markers, such as neuron specific enolase and S-100b, may contribute to predict prognosis after CA. To the contrary, when used individually the necessary precision remains poorly characterized. Biochemical studies suffer from substantial methodological differences hampering attempts to summarize their findings. We review the information available on biochemical markers of brain damage for neurological prognostication after CA.