Table 1 ESM: Flow Chart

ELECTRONIC SUPPLEMENTARY MATERIAL

Additional Tables

Table 1 ESM: Flow chart

Additional Figures

Detailed description of the 5 categories of the Cerebral Performance Categories Scale (CPC)(Edgren E, Hedstrand U, Kelsey S, Sutton-Tyrrell K, Safar P (1994) Assessment of neurological prognosis in comatose survivors of cardiac arrest. BRCT I Study Group. Lancet 343:1055-1059.):

CPC 1: Good cerebral performance (normal life: Conscious, alert, able to work and lead a normal life; may have minor psychological or neurologic deficits (mild dysphasia, non-incapacitating hemiparesis, or minor cranial nerve abnormalities).

CPC 2: Moderate cerebral disability (disabled but independent):Conscious, sufficient cerebral function for part-timework in sheltered environment or independentactivities of daily life (dress, travel by publictransportation, food preparation); may havehemiplegia, seizures, ataxia, dysarthria, dysphasia, orpermanent memory or mental changes.

CPC 3: Severe cerebral disability (conscious but disabled and dependent):Conscious, dependent on others for daily support (inan institution or at home with exceptional familyeffort); has at least limited cognition. This categoryincludes a wide range of cerebral abnormalities, from patients who are ambulatory but have severe memory disturbances or dementia precluding independent existence to those who are paralyzed and can communicate only with their eyes, as in the locked-in syndrome.

CPC 4: Coma/vegetative state (unconscious): Unconscious, unaware of surroundings, no cognition. No verbal or psychological interaction with environment.

CPC 5: Brain death (certified brain dead or dead by traditional criteria).

Table 2 ESM: Reclassification analysis SN 0-48 h and NSE 0-72h separately added to the clinical model

AUC…area under the curve; IDI…integrated discrimination improvement; NRI …net reclassification improvement; SN…secretoneurin; NSE…neuron- specific enolase

The clinical model comprises age, first monitored rhythm, time to ROSC, MTH, bystander initiated CPR and lactate.
Table 3 ESM: Distribution of ancillary prognostic variables after cardiac arrest

VariablepatientsGood outcomePoor outcome

Computed tomography8629 (33.7)57 (66.3)

Global edema06 (7.0)

Decreased grey/white matter differentiation028 (32.6)

None of the above patterns29 (33.7)23 (26.7)

SSEP8027 (33.8)50 (62.5)

N20 absent029 (36.3)

N20 pathologic but present15 (18.8)12 (15.0)

N20 normal12 (15.0)9 (11.3)

Peripheral dysfunction3 (3.7)

EEG7727 (35.1)50 (64.9)

Malignant patterns047 (61.0)

Generalized suppression, non-reactive26 (33.7)

Generalized burst-suppression9 (11.7)

Status epilepticus12 (15.6)

Benign patterns*27 (35.1)3 (3.9)

*Any clear and reproducible change in amplitude or frequency of EEG background on stimulation, excluding stimulus-induced rhythmic, periodic or irritative discharges or induction of muscle artifact alone.

Additional Figures

Figure 1 ESM: SN kinetics

Figure 2 ESM: NSE kinetics

Figure 3 ESM: Good outcome – MTH

Figure 4 ESM: Poor outcome – MTH

Figure Legends

Figure 1 ESM: SN kinetics

SN (fmol/ml) in 24 h intervals up to 168 h; Graph shows median and range.

Figure 2 ESM: NSE kinetics

NSE (ng/ml) in 24 h intervals up to 168 h; Graph shows median and range.

Figure 3 ESM: Good outcome – MTH

SN levels (fmol/ml) of patients with good neurological outcome treated with mild therapeutic hypothermia or normothermia

Figure 4 ESM: Poor outcome – MTH

SN levels (fmol/ml) of patients with poor neurological outcome treated with mild therapeutic hypothermia or normothermia