Sport-caught fish and breast cancer. Angling for more data

Neurologic disability is a feared outcome of resuscitation from cardiac arrest. The study by Rech and colleagues in the previous issue of Critical Care describes the use of neuron-specific enolase to inform an early prognosis in patients who survived in-hospital cardiac arrest. In their study 'none of the patients had a DNR order and there was no limitation of life support.' As a result, 10% of patients remained in a vegetative state at 6 months, a higher percentage than in other recent studies. The existence of a population of patients in which all are fully supported without withholding care or withdrawal of care may represent an important research opportunity. High neuron-specific enolase levels have been reported in patients that awoke and seem to occur in studies with a higher percentage of patients in a vegetative state at follow-up (more uniform support). If a comprehensive set of clinical, electrophysiological, biochemical and imaging measures could be obtained in a uniform manner in a cohort of patients without limitations in care, a more objective set of comprehensive prognostic indicators could be obtained. A focused international consortium is called for. Neurologic disability is a feared outcome of resuscitation from cardiac arrest. The study by Rech and colleagues in the previous issue of Critical Care describes the use of neuron-specific enolase (NSE) to inform an early prognosis in 43 patients who survived for more than 12 hours after resuscitation from in-hospital cardiac arrest [1]. A reliable early neurologic prognosis can help families make decisions about continuing life-sustaining care, but also to adjust expectations. If the prognosis suggests little chance of awakening, many medical professionals and lay people feel that continuing life unconscious or vegetative can be ethically avoided – others disagree [2,3]. Care practices at the end of life, including the withholding of and withdrawal of life-sustaining food and hydration, vary considerably across Europe, and differ by factors including region and religion of both the physician and the patient [4]. In a recent study of care after resuscitation from cardiac arrest from the United States, 69% of patients had care either withheld or withdrawn after information about prognosis was discussed with the family [5]. Compare this with Rech and colleagues' study, where 'none of the patients had a DNR order and there was no limitation of life support' [1]. It is interesting to note that despite this full support, 70% of patients died by their …