MedicalResearch.com Interview with:
Marion Moseby-Knappe, MD
Neurologist and Researcher
Center for Cardiac Arrest at Lund University and
Skane University Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our research focuses on improving methods for examining unconscious patients treated on intensive care units after cardiac arrest. If a patient does not wake up within the first days after cardiac arrest, physicians need to evaluate how likely it is that the patient will awaken at all and to which extent there is brain injury.
According to European and American guidelines, decisions on further medical treatment of cardiac arrest patients should always be based on a combination of examinations and not only one single method. Various methods are combined when assessing the patient such as examining different neurologic reflexes, head scans (computed tomography or magnetic resonance imaging), other specialist examinations (electroencephalogram or somatosensory evoked potentials) or blood markers.
Our research focuses on patients included in the largest cardiac arrest trial to date, the Targeted Temperature Management after Out-of-Hospital Cardiac Arrest (TTM) Trial.
MedicalResearch.com: What are the main findings?
Response: In the recently published study with over 700 included patients, we found that a protein called Neurofilament light chain (NFL) in blood could identify patients with extensive brain injury as early as 24 hours after cardiac arrest. NFL was analyzed with a new and ultrasensitive method, called Simoa. Only small blood volumes are needed for this test, which can be collected from the patient together with routine blood samples. In our study, NFL also had the potential to identify patients with little or no brain injury, which is really interesting, because so far no other method has been able to identify patients with good outcome.
MedicalResearch.com: What should readers take away from your report?
Response: We found, that NFL 24 hours after cardiac arrest could better identify patients with poor neurologic outcome (ranging from severe disability to brain death at 6 months after cardiac arrest) than any of the routine examinations used today. If our results can be confirmed in further research, NFL could become a new routine tool for examining unconscious patients after cardiac arrest. Currently, NFL is not routinely available to patients, because reference standards need to be established first, meaning that further research is required to decide which values should be considered normal and which are to be considered elevated.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our results of serum NFL need to be validated in large clinical trials with cardiac arrest patients. Also, a reference standard needs to be established, so that blood values can be compared even if samples were analyzed in different laboratories. In future, we will also investigate if any specific combination with routine methods of examining unconscious cardiac arrest patients is even better than NFL alone.
MedicalResearch.com: Is there anything else you would like to add?
Response: This research is an international collaboration from the Targeted Temperature Management after Out-of-Hospital Cardiac Arrest (TTM) Trial and I would like to thank all the collaborators and funders for their contributions. The funders had no influence on the design of the study nor on publication of results.
I have no conflicts of interest.
Moseby-Knappe M, Mattsson N, Nielsen N, et al. Serum Neurofilament Light Chain for Prognosis of Outcome After Cardiac Arrest. JAMA Neurol. Published online October 29, 2018. doi:10.1001/jamaneurol.2018.3223
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