Automated Quantitative Pupillometry for the Prognostication of Coma After Cardiac Arrest

Suys, Tamarah; Bouzat, Pierre; Marques‐Vidal, Pedro; Sala, Nathalie; Payen, Jean François; Rossetti, Andrea O.; Oddo, Mauro

doi:10.1007/s12028-014-9981-z

Cited by 81 publications

(52 citation statements)

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“…Preliminary single-center studies, evaluating the value of quantitative pupillometry, focused exclusively on the qPLR and found variable cut-offs of 100% specificity for poor prognosis, with thresholds varying from 10% [16] to 13% [17, 18]. These studies used other devices that did not compute automated NPi.…”

Section: Discussionmentioning

confidence: 99%

“…those maximizing the Youden index and the specificity, were also identified. According to Jones et al [29], based on a specificity of 95% for qPLR in previous studies [16–18], a 95% confidence interval of 3%, and a prevalence of poor neurological outcome of 50%, a sample size of at least 400 patients was calculated. Statistical analysis was performed using STATA 12 (STATA ® , College Station, TX, USA).…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2018

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PurposeTo assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA).MethodsWe 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).ResultsAt 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)].ConclusionsQuantitative 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.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5448-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

et al. 2018

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“…15 The device integrated a calibrated light stimulation (320lx, 1 second) that allowed the rapid and precise measurement (0.05mm limit) of pupil size and reactivity.…”

Section: Automated Quantitative Pupillometrymentioning

confidence: 99%

“…4,9 Automated infrared pupillometry provides a quantitative measure of pupil size, pupillary light reflex (PLR), and constriction velocity, and is emerging as a novel modality to evaluate brainstem function at the bedside in critically ill patients. [13][14][15] Here, we examined, using a blinded approach, the accuracy of quantitative PLR in predicting 1-year neurological recovery of comatose CA patients. [13][14][15] Here, we examined, using a blinded approach, the accuracy of quantitative PLR in predicting 1-year neurological recovery of comatose CA patients.…”

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Early prediction of coma recovery after cardiac arrest with blinded pupillometry

Solari¹,

Rossetti

Carteron

et al. 2017

Annals of Neurology

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“…There is evidence that detection of pupillary response using clinical examination is relatively inaccurate[19]. Quantitative detection using a pupillometer may increase accuracy of this sign[20]. …”

Section: Type Of Prognostic Indexesmentioning

confidence: 99%

Neurological prognostication after cardiac arrest

Sandroni

Geocadin

2015

Current Opinion in Critical Care

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Purpose of review Prediction of neurological prognosis in patients who are comatose after successful resuscitation from cardiac arrest remains difficult. Previous guidelines recommended ocular reflexes, somatosensory evoked potentials and serum biomarkers for predicting poor outcome within 72h from cardiac arrest. However, these guidelines were based on patients not treated with targeted temperature management and did not appropriately address important biases in literature. Recent findings Recent evidence reviews detected important limitations in prognostication studies, such as low precision and, most importantly, lack of blinding, which may have caused a self-fulfilling prophecy and overestimated the specificity of index tests. Maintenance of targeted temperature using sedatives and muscle relaxants may interfere with clinical examination, making assessment of neurological status before 72 h or more after cardiac arrest unreliable. Summary No index predicts poor neurological outcome after cardiac arrest with absolute certainty. Prognostic evaluation should start not earlier than 72 h after ROSC and only after major confounders have been excluded so that reliable clinical examination can be made. Multimodality appears to be the most reasonable approach for prognostication after cardiac arrest.

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Automated Quantitative Pupillometry for the Prognostication of Coma After Cardiac Arrest

Abstract: Quantitative PLR is more accurate than standard PLR in predicting outcome of post-anoxic coma, irrespective of temperature and sedation, and has comparable prognostic accuracy than EEG and SSEP.

Cited by 81 publications

References 30 publications

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

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

Early prediction of coma recovery after cardiac arrest with blinded pupillometry

Neurological prognostication after cardiac arrest

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