Assessment of cerebral injury with spinal fluid creatine kinase (CSF-CK) in patients after cardiac resuscitation.

Serial determinations of creatine kinase in cerebrospinal fluid (CSF) were made in eighty-two patients, that were comatose after cardiac resuscitation because of ventricular fibrillation. In all patients who remained unconscious creatine kinase (CSF-CK) increased from less than 2 U/L to 11 U/L or more with maximum CSF-CK averaging 53 +/- 6 U/L 48-72h after resuscitation. In patients who recovered consciousness maximum CSF-CK activity never exceeded 11 U/L. However, maximum CSF-CK activity between 5 and 11 U/L was always associated with some permanent cerebral dysfunction. Complete cerebral restitution was only observed when maximum CSF-CK was 5 U/L or less. In some patients a maximum CK activity of 4 U/L was associated with depressed memory functions. The blood-brain barrier was impermeable to CK as evidenced by isoenzyme analysis and lack of correlation between CK activity in CSF and peripheral blood. CSF-pressure rose slightly to 217 +/- 11 mmH2O in patients with CSF-CK above 10 U/L and to 197 +/- 15 mmH2O when CSF-CK was below 5 U/L. The results indicate that high CSF-CK activity, whether appearing early or late after successful cardiac resuscitation, effectively predicts an unfavourable outcome of global cerebral ischemia. No rise in CSF-CK was always indicative of full cerebral recovery.