Hjertestans og bruk av CKBB som prognostisk markør.

Background: Survivors after cardiac arrest may develop anoxic brain damage, and a long lasting respirator treatment after resuscitation makes it difficult to judge the cerebral function. The brain contains large concentrations of creatin kinase BB isoenzyme (CKBB), which normally do not exist in the cerebrospinal fluid (CSF). If cardiac arrest with a following brain damage occurs, CKBB may have a peak in the CSF after 48-72 hours. Because of this the CKBB level in the cerebrospinal fluid 48 hours after cardiac arrest could be a prognostic measurement for the degree of brain damage. Materials and methods: Our study includes 117 patients with cardiac arrest who were admitted to Ullevål University Hospital in the period 01.01.2001-30.06.2004. All the patients were initially successfully resuscitated outside hospital. In a retrospective and prospective study we have looked at the patients degree of brain damage compaired to their CKBB values. Results: Of the 117 patients, 65 (56%) died in hospital. Ventricular fibrillation was the most common reason for cardiac arrest (73%). 52% of these patients survived. Of those who had asystoli when the ambulance arrived, 75% died. We have only measured the CKBB value in 34 patients. Among these 34, 25 (74%) died. Their mean CKBB value was 96 UL. For comparison, the similar value among the survivors was 4 UL. Among the totally 117 patients, 49 (42%) got a severe brain damage. Of these 49, 24 (49%) were spinal tapped with a mean CKBB value of 100 UL. All these patients died. 45 patients survived without any sequele. Only 8 of these patients were spinal tapped , with a mean CKBB value of 4 UL. Conclusion: The mortality after cardiac arrest is high and most of the patients die as a result of anoxic brain damage. The CKBB activity in the spinal fluid correlates well with the cerebral prognosis, where high CKBB value is connected to bad prognosis. The use of CKBB has lately, though, been reduced because of increased risk of bleeding after percutan coronar intervention (PCI) and therapeutic hypothermia. At the same time the use of new and better methods, like somatosensory evoked potentials (SEP), are increasing