Neurological pupil index and its association with other prognostic tools after cardiac arrest: A post hoc analysis.
Details
Serval ID
serval:BIB_8CCB502279ED
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Neurological pupil index and its association with other prognostic tools after cardiac arrest: A post hoc analysis.
Journal
Resuscitation
ISSN
1873-1570 (Electronic)
ISSN-L
0300-9572
Publication state
Published
Issued date
10/2022
Peer-reviewed
Oui
Volume
179
Pages
259-266
Language
english
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Publication Status: ppublish
Abstract
We evaluated the concordance of the Neurological pupil Index (NPi) with other predictors of outcome after cardiac arrest (CA).
Post hoc analysis of a prospective, international, multicenter study including adult CA patients. Predictors of unfavorable outcome (UO, Cerebral Performance Category of 3-5 at 3 months) included: a) worst NPi ≤ 2; b) presence of discontinuous encephalography (EEG) background; c) bilateral absence of N20 waves on somatosensory evoked potentials (N20 <sub>ABS</sub> ); d) peak neuron-specific enolase (NSE) blood levels > 60 mcg/L; e) myoclonus, which were all tested in a subset of patients who underwent complete multimodal assessment (MMM).
A total of 269/456 (59 %) patients had UO and 186 (41 %) underwent MMM. The presence of myoclonus was assessed in all patients, EEG in 358 (78 %), N20 in 186 (41 %) and NSE measurement in 228 (50 %). Patients with discontinuous EEG, N20 <sub>ABS</sub> or high NSE had a higher proportion of worst NPi ≤ 2. The accuracy for NPi to predict a discontinuous EEG, N20 <sub>ABS</sub> , high NSE and the presence of myoclonus was moderate. Concordance with NPi ≤ 2 was high for NSE, and moderate for discontinuous EEG and N20 <sub>ABS</sub> . Also, the higher the number of concordant predictors of poor outcome, the lower the observed NPi.
In this study, NPi ≤ 2 had moderate to high concordance with other unfavorable outcome prognosticators of hypoxic-ischemic brain injury. This indicates that NPi measurement could be considered as a valid tool for coma prognostication after cardiac arrest.
Post hoc analysis of a prospective, international, multicenter study including adult CA patients. Predictors of unfavorable outcome (UO, Cerebral Performance Category of 3-5 at 3 months) included: a) worst NPi ≤ 2; b) presence of discontinuous encephalography (EEG) background; c) bilateral absence of N20 waves on somatosensory evoked potentials (N20 <sub>ABS</sub> ); d) peak neuron-specific enolase (NSE) blood levels > 60 mcg/L; e) myoclonus, which were all tested in a subset of patients who underwent complete multimodal assessment (MMM).
A total of 269/456 (59 %) patients had UO and 186 (41 %) underwent MMM. The presence of myoclonus was assessed in all patients, EEG in 358 (78 %), N20 in 186 (41 %) and NSE measurement in 228 (50 %). Patients with discontinuous EEG, N20 <sub>ABS</sub> or high NSE had a higher proportion of worst NPi ≤ 2. The accuracy for NPi to predict a discontinuous EEG, N20 <sub>ABS</sub> , high NSE and the presence of myoclonus was moderate. Concordance with NPi ≤ 2 was high for NSE, and moderate for discontinuous EEG and N20 <sub>ABS</sub> . Also, the higher the number of concordant predictors of poor outcome, the lower the observed NPi.
In this study, NPi ≤ 2 had moderate to high concordance with other unfavorable outcome prognosticators of hypoxic-ischemic brain injury. This indicates that NPi measurement could be considered as a valid tool for coma prognostication after cardiac arrest.
Keywords
Adult, Heart Arrest/complications, Heart Arrest/diagnosis, Heart Arrest/therapy, Humans, Myoclonus, Phosphopyruvate Hydratase, Prognosis, Prospective Studies, Pupil/physiology, Automated pupillometer, Automated pupillometry, Brain injury, Concordance, Heart arrest
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Create date
15/08/2022 13:38
Last modification date
05/10/2023 5:59
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