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

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Serveur académique Lausannois

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info:eu-repo/semantics/altIdentifier/doi/10.1007/s00134-018-5448-6

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info:eu-repo/semantics/altIdentifier/pmid/30478620

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info:eu-repo/semantics/altIdentifier/eissn/1432-1238

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info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_0E3027EAFAD97

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Serveur Académique Lausannois

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Université de Lausanne et CHUV

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info:eu-repo/semantics/openAccess , CC BY-NC 4.0 , https://creativecommons.org/licenses/by-nc/4.0/

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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

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Standard of value Sudden cardiac death Cardiopulmonary arrest Arrest, Cardiac Heart arrest

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M. Oddo et al., « Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study. », Serveur académique Lausannois, ID : 10.1007/s00134-018-5448-6

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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  

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