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

Détails

Ressource 1Télécharger: 30478620_BIB_0E3027EAFAD9.pdf (1327.67 [Ko])
Etat: Public
Version: Final published version
Licence: CC BY-NC 4.0
ID Serval
serval:BIB_0E3027EAFAD9
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study.
Périodique
Intensive care medicine
Auteur(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
Statut éditorial
Publié
Date de publication
12/2018
Peer-reviewed
Oui
Volume
44
Numéro
12
Pages
2102-2111
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article ; Multicenter Study ; Observational Study
Publication Status: ppublish
Résumé
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.
Mots-clé
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
Oui
Création de la notice
24/12/2018 10:47
Dernière modification de la notice
05/11/2019 6:11
Données d'usage