Resuscitative value of B-type natriuretic peptide in comatose survivors treated with hypothermia after out-of-hospital cardiac arrest due to cardiac causes.

BACKGROUND: Two randomized studies have shown a neurological benefit of therapeutic hypothermia in comatose survivors after out-of-hospital cardiac arrest, but there are no studies of the cardiac neurohormone of B-type natriuretic peptide (BNP) in patients treated with hypothermia.

METHODS AND RESULTS: A prospective study was conducted of 109 comatose patients who were treated with mild hypothermia after out-of-hospital sudden cardiac arrest due to cardiac causes and whose BNP level was measured on arrival at the emergency room. The primary endpoint was a favorable neurological outcome at the time of hospital discharge. A total of 45 of the 109 patients had a favorable neurological outcome. The unadjusted rate of a favorable neurological outcome decreased in a stepwise fashion among patients in increasing quartiles of BNP level (p<0.001) and this association remained significant in subgroups of patients. The BNP cutoff value of 80 pg/ml for a favorable neurological outcome had an accuracy of 87.2%. In the multiple logistic-regression analysis, a BNP level of 80 pg/ml or less was an independent predictor of favorable neurological outcome.

CONCLUSIONS: The measurement of BNP was found to provide valuable information regarding the neurological outcome of comatose survivors treated with mild hypothermia after out-of-hospital cardiac arrest due to cardiac causes.