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

Details

Ressource 1Download: 30478620_BIB_0E3027EAFAD9.pdf (1327.67 [Ko])
State: Public
Version: Final published version
License: CC BY-NC 4.0
Serval ID
serval:BIB_0E3027EAFAD9
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study.
Journal
Intensive care medicine
Author(s)
Oddo M., Sandroni C., Citerio G., Miroz J.P., Horn J., Rundgren M., Cariou A., Payen J.F., Storm C., Stammet P., Taccone F.S.
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Publication state
Published
Issued date
12/2018
Peer-reviewed
Oui
Volume
44
Number
12
Pages
2102-2111
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Multicenter Study ; Observational Study
Publication Status: ppublish
Abstract
To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA).
We 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).
At 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)].
Quantitative 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.
Keywords
Aged, Coma/diagnosis, Coma/etiology, Coma/mortality, Critical Care, Double-Blind Method, Evoked Potentials, Somatosensory, Female, Glasgow Coma Scale, Heart Arrest/complications, Heart Arrest/diagnosis, Heart Arrest/mortality, Humans, Male, Middle Aged, Outcome Assessment (Health Care), Prognosis, Prospective Studies, Reflex, Pupillary, Sensitivity and Specificity, Cardiac arrest, Neurological pupil index, Outcome, Prognostication, Pupillary reactivity, Pupillometry
Pubmed
Web of science
Open Access
Yes
Create date
24/12/2018 10:47
Last modification date
05/11/2019 6:11
Usage data