Neurological Pupil Index for Early Prognostication Following Veno-Arterial Extracorporeal Membrane Oxygenation.

Détails

ID Serval
serval:BIB_1B68762E6EB1
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Neurological Pupil Index for Early Prognostication Following Veno-Arterial Extracorporeal Membrane Oxygenation.
Périodique
Chest
Auteur⸱e⸱s
Miroz JP. (co-premier), Ben-Hamouda N. (co-premier), Bernini A., Romagnosi F., Bongiovanni F., Roumy A., Kirsch M., Liaudet L., Eckert P., Oddo M.
ISSN
1931-3543 (Electronic)
ISSN-L
0012-3692
Statut éditorial
Publié
Date de publication
05/05/2020
Peer-reviewed
Oui
Volume
157
Numéro
5
Pages
1167-74
Langue
anglais
Notes
Publication types: Journal Article
Résumé
Veno-arterial extra-corporeal membrane oxygenation therapy (VA-ECMO) following refractory cardiogenic shock (r-CS) or cardiac arrest (r-CA) has significant morbidity and mortality. Early outcome prediction is crucial in this setting, but data on neuro-prognostication are limited. We examined the prognostic value of clinical neurological examination, using an automated device for the quantitative measurement of pupillary light reactivity.
An observational cohort of sedated mechanically ventilated VA-ECMO patients was analyzed at the early phase following ECMO insertion (first 72 hours). Using the NPi®-200 automated infrared pupillometer, pupillary light reactivity was assessed repeatedly (every 12 hours) by calculating the Neurological Pupil index (NPi). Trends of NPi over time were correlated to 90-day mortality, and the prognostic performance of the NPi, alone and in combination with the 12-h PREDICT VA-ECMO score, was evaluated.
A total 100 consecutives patients were studied (51 r-CS/49 r-CA; 12-h PREDICT VA-ECMO 40%; observed 90-day survival 43%). Non-survivors (n=57) had significantly lower NPi than survivors at all time-points (all p<0.01). Abnormal NPi (<3, at any time from 24 to 72 hours) was 100% specific for 90-day mortality, with 0% false positives. Adding 12-h PREDICT VA-ECMO score to the NPi provided the best prognostic performance (specificity 100% [95% confidence interval 91-100%], sensitivity 60% [46-72%], area under the ROC curve 0.82).
Quantitative NPi alone had excellent ability to predict a poor outcome from day 1 after VA-ECMO insertion, with no false positives. Combining NPi and 12-h PREDICT-VA ECMO score increased sensitivity of outcome prediction, while maintaining 100% specificity.
Mots-clé
Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine, Cardiology and Cardiovascular Medicine, ECMO, Neurological Pupil index, Outcome, Prognostication, Pupillometry
Pubmed
Création de la notice
21/12/2019 16:06
Dernière modification de la notice
20/01/2021 20:30
Données d'usage