Abstract 19470: Biomarkers in Cardiac Arrest: A Systematic Review

• Published in: Circulation (New York, N.Y.) N.Y.), 2016-11, Vol.134 (Suppl_1 Suppl 1), p.A19470-A19470
• Main Authors: Karlsson, Carl M, Moskowitz, Ari, Aquino, Gabrielle, Sanfilippo, Alexandra, Zhu, Jessica, McErlean, Daniel, Andersen, Lars W, Donnino, Michael
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

IntroductionPost cardiac arrest (CA) patients suffer from a post CA syndrome with a high degree of mortality and neurologic morbidity. As such, the use of biomarkers to identify poor outcomes has been an active area of investigation in the field of resuscitation science. Despite the large amount of research done in the post-CA syndrome, there is currently no systematic review evaluating the comprehensive set of tested biomarkers and their relationship to outcome.HypothesisIn the present study we report the prognostic capacity of post-CA biomarkers in a comprehensive systematic review.MethodsThe electronic databases MEDLINE and EMBASE were queried from inception until October 2015 using a comprehensive search strategy. Two reviewers initially assessed the eligibility of these articles based on abstracts. Duplicates, animal studies, in-vitro studies, studies of mechanical biomarkers (e.g. EEG), articles without abstracts, non-relevant and non-English articles were excluded. The full texts of these articles had their main results abstracted.ResultsA total of 6,632 articles were initially identified; 4,119 from MEDLINE and 2,723 from EMBASE, with 444 unique articles eligible for full-text review. In total, 232 individual biomarkers have been studied as potential prognostic tools for post-CA care. Lactate (114 studies) and Neuron Specific Enolase (NSE) (79 studies) were the most commonly investigated biomarkers. Studies tended to be small but varied in size with a median sample size of 67 patients (IQR 34-134). The studies demonstrated significant heterogeneity in patient population, time of measurement, outcome predicted (e.g. death vs. neurologic disability), and follow-up period. Currently, no biomarker has been shown to be universally predictive of significant neurologic impairment or death.ConclusionsOver 400 studies have investigated over 200 biomarkers for use as prognostic tools in the post-CA period. NSE and lactate in particular, have been extensively studied and are associated with mortality and poor neurologic outcome. Unfortunately, studies of post-CA biomarkers tend to suffer from small sample sizes and heterogeneous methodology, limiting pooled analysis, and comparative testing.