Quantitative assessment of pupillary light reflex for early prediction of outcomes after out-of-hospital cardiac arrest: A multicentre prospective observational study

Tamura, Tomoyoshi; Namiki, Jun; Sugawara, Yoko; Sekine, Keitaro; Yo, Kikuo; Kanaya, Takahiro; Yokobori, Shoji; Roberts, Rachel; Abe, Takayuki; Yokota, Hiroyuki; Sasaki, Junichi

doi:10.1016/j.resuscitation.2018.06.027

Cited by 48 publications

(41 citation statements)

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“…Descriptive statistics, comparisons of binary variables, mixed-effects model for the differences of repeated measurements between the outcome groups, and receiver operating characteristics (ROC) curve analysis for the comparison of the area under the curve (AUC) values were performed as previously reported [9]. Mann-Whitney U-test was used for the comparison of differences between not normally distributed groups.…”

Section: Discussionmentioning

confidence: 99%

“…This study is a post-hoc analysis of a multicenter, single-arm, uncontrolled, prospective, observational study that focused on quantitative PLR as a representative parameter of pupillary responses (clinical trial identifier: UMIN000015658) [9]. This study was approved by the IRB of each participating institution (Keio University School of Medicine, Ethics Committee; Institutional Review Board of Nippon Medical School; Research Ethics Committee, Tokyo Saiseikai Central Hospital; and Independent Ethics Committee of Hiratsuka City Hospital).…”

Section: Study Design and Settingmentioning

confidence: 99%

“…Patient body temperature was managed at 33-36˚C (TTM) or with fever control for non-cardiogenic CA due to subarachnoid hemorrhage or sepsis. Non-comatose (GCS >8 in the ED) post-CA patients were also enrolled but did not undergo therapeutic hypothermia [9].…”

Section: Selection Of Patients and Data Collectionmentioning

confidence: 99%

“…Several publications reported the prognostic superiority of the quantitative assessment of PLR over the qualitative evaluation of PLR before 72 h after CA [5][6][7][8][9]. Recently, we have reported that quantitative values of PLR in survivors or in patients with favorable neurological outcomes were consistently greater than values in non-survivors or in patients with unfavorable outcomes, respectively, within 72 h following the return of spontaneous circulation (ROSC) after OHCA [9]. Notably, quantitative PLR strongly predicted 90-day survival and favorable neurological outcomes as early as 0 h after ROSC.…”

Section: Introductionmentioning

confidence: 99%

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Early outcome prediction with quantitative pupillary response parameters after out-of-hospital cardiac arrest: A multicenter prospective observational study

et al. 2020

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We aimed to determine the characteristics of quantitative pupillary response parameters other than amplitude of pupillary light reflex (PLR) early after return of spontaneous circulation (ROSC) and their implications for predicting neurological outcomes early after cardiac arrest (CA). Fifty adults resuscitated after non-traumatic out-of-hospital CA from four emergency hospitals were enrolled. Pupil diameters, PLR, constriction velocity (CV), maximum CV (MCV), dilation velocity (DV), latency of constriction, and Neurological Pupil index (NPi) were quantitatively measured at 0, 6, 12, 24, 48, and 72 h post-ROSC using an automated pupillometer. Change over time of each parameter was compared between favorable (Cerebral Performance Category [CPC] 1 or 2) and unfavorable neurological outcome (CPC 3-5) groups. Prognostic values of 90-day favorable outcome by these parameters and when combined with clinical predictors (witness status, bystander cardiopulmonary resuscitation, initial shockable rhythm, implementation of target temperature management) were tested. Thirteen patients achieved favorable outcome. CV, MCV, DV (P < 0.001), and NPi (P = 0.005) were consistently greater in the favorable group than in the unfavorable outcome group. Change over time was not statistically different between the groups in all parameters. CV, MCV, DV (ρ = 0.96 to 0.97, P < 0.001, respectively), and NPi (ρ = 0.65, P < 0.001) positively correlated with PLR. The prognostic value of 0-hour CV (area under the curve, AUC [95% confidence interval]: 0.92 [0.80-1.00]), , and NPi (0.88 [0.74-1.00]) was equivalent to that of . Prognostic values improved to AUC of 0.95-0.96 when 0hour PLR, CV, DV, or NPi was combined with clinical predictors. The 0-hour CV, MCV, and NPi showed equivalent prognostic values to PLR alone/in combination with clinical predictors. Using PLR among several quantitative pupillary response parameters for early neurological prognostication of post-CA patients is a simple and effective strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Study Design and Settingmentioning

confidence: 99%

Section: Selection Of Patients and Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early outcome prediction with quantitative pupillary response parameters after out-of-hospital cardiac arrest: A multicenter prospective observational study

et al. 2020

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“…Recent studies have suggested that quantitative PLR (qPLR; expressed as the percentage pupillary constriction to a calibrated light stimulus) may improve prediction of neurological outcome after CA [16–19]. Most of these studies, however, were single-centered and had both a small sample size and/or an absent or incomplete blinding, and only qPLR was examined.…”

Section: Introductionmentioning

confidence: 99%

Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study

et al. 2018

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PurposeTo assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA).MethodsWe performed a prospective international multicenter study (10 centers) in adult comatose CA patients. Quantitative NPi and standard manual pupillary light reflex (sPLR)—blinded to clinicians and outcome assessors—were recorded in parallel from day 1 to 3 after CA. Primary study endpoint was to compare the value of NPi versus sPLR to predict 3-month Cerebral Performance Category (CPC), dichotomized as favorable (CPC 1–2: full recovery or moderate disability) versus unfavorable outcome (CPC 3–5: severe disability, vegetative state, or death).ResultsAt any time between day 1 and 3, an NPi ≤ 2 (n = 456 patients) had a 51% (95% CI 49–53) negative predictive value and a 100% positive predictive value [PPV; 0% (0–2) false-positive rate], with a 100% (98–100) specificity and 32% (27–38) sensitivity for the prediction of unfavorable outcome. Compared with NPi, sPLR had significantly lower PPV and significantly lower specificity (p < 0.001 at day 1 and 2; p = 0.06 at day 3). The combination of NPi ≤ 2 with bilaterally absent somatosensory evoked potentials (SSEP; n = 188 patients) provided higher sensitivity [58% (49–67) vs. 48% (39–57) for SSEP alone], with comparable specificity [100% (94–100)].ConclusionsQuantitative NPi had excellent ability to predict an unfavorable outcome from day 1 after CA, with no false positives, and significantly higher specificity than standard manual pupillary examination. The addition of NPi to SSEP increased sensitivity of outcome prediction, while maintaining 100% specificity.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5448-6) contains supplementary material, which is available to authorized users.

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Neurologic prognostication after resuscitation from cardiac arrest

2020

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Out‐of‐hospital cardiac arrest remains a leading cause of mortality in the United States, and the majority of patients who die after achieving return of spontaneous circulation die from withdrawal of care due to a perceived poor neurologic prognosis. Unfortunately, withdrawal of care often occurs during the first day of admission and research suggests this early withdrawal of care may be premature and result in unnecessary deaths for patients who would have made a full neurologic recovery. In this review, we explore the evidence for neurologic prognostication in the emergency department for patients who achieve return of spontaneous circulation after an out‐of‐hospital cardiac arrest.

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Quantitative assessment of pupillary light reflex for early prediction of outcomes after out-of-hospital cardiac arrest: A multicentre prospective observational study

Cited by 48 publications

References 23 publications

Early outcome prediction with quantitative pupillary response parameters after out-of-hospital cardiac arrest: A multicenter prospective observational study

Early outcome prediction with quantitative pupillary response parameters after out-of-hospital cardiac arrest: A multicenter prospective observational study

Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study

Neurologic prognostication after resuscitation from cardiac arrest

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Quantitative assessment of pupillary light reflex for early prediction of outcomes after out-of-hospital cardiac arrest: A multicentre prospective observational study

Cited by 48 publications

References 23 publications

Early outcome prediction with quantitative pupillary response parameters after out-of-hospital cardiac arrest: A multicenter prospective observational study​

Early outcome prediction with quantitative pupillary response parameters after out-of-hospital cardiac arrest: A multicenter prospective observational study​

Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study

Neurologic prognostication after resuscitation from cardiac arrest

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Early outcome prediction with quantitative pupillary response parameters after out-of-hospital cardiac arrest: A multicenter prospective observational study

Early outcome prediction with quantitative pupillary response parameters after out-of-hospital cardiac arrest: A multicenter prospective observational study