Neurological Pupil Index and Pupillary Light Reflex by Pupillometry Predict Outcome Early After Cardiac Arrest

Riker, Richard R.; Sawyer, Mary; Fischman, Victoria; May, Teresa; Lord, Christine; Eldridge, Ashley; Seder, David B.

doi:10.1007/s12028-019-00717-4

Cited by 81 publications

(84 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In other studies [50,62,109,114], burst suppression (undefined, or not ACNS-defined) predicted poor outcome with inconsistent accuracy both within 24 h or at 24-72 h after ROSC (Table 30). In one study [65] 33,34) was much less specific than burst-suppression for predicting poor outcome. We defined "not continuous" as an EEG pattern where suppression was present for more than 10% of the recording.…”

Section: Eeg Background (Tablesmentioning

confidence: 94%

“…Target temperature varied across studies (ESM Table E3). Fifteen studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] were included for clinical examination, 12 for biomarkers [37][38][39][40][41][42][43][44][45][46][47][48], 26 for electrophysiology , and 15 for imaging [75][76][77][78][79][80][81][82][83][84][85][86][87][88][89], while 26 studies were included for more than one prognostic modality.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Sensitivity and FPR for index tests based on clinical examination, biomarkers, electrophysiology, and imaging are reported in Tables 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,…”

Section: Study Characteristicsmentioning

confidence: 99%

“…A summary of the ACNS EEG terminology is reported in ESM Table E4. 22,23,24,25,26,27,28,29,30,31,32,33,34,35,36) In one study [69], an isoelectric EEG, defined as all activity below 2 µV, predicted poor outcome at 12 and 72 h from ROSC with 0% FPR and high precision (95% CIs 0-4%) ( Table 22). In six studies, a suppressed EEG background defined according to the ACNS terminology (i.e., all activity of the record < 10 µV; see ESM Table E4) almost invariably predicted a poor neurological outcome [52,53,61,68,69,72], especially after 16-24 h from ROSC.…”

Section: And Esm Fig 3)mentioning

confidence: 99%

See 3 more Smart Citations

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

View full text Add to dashboard Cite

Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3-5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods: PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results: Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2-5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion: In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169

show abstract

Section: Eeg Background (Tablesmentioning

confidence: 94%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: And Esm Fig 3)mentioning

confidence: 99%

See 2 more Smart Citations

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Automated pupillometry has shown much more promise to predict survival with a good neurologic outcome (Table 2). 31–36 Automated pupillometry studies have shown improved accuracy for early prognosis, but most are unblinded and potentially limited by confirmation bias (ie, the self‐fulfilling prophecy of having a test influence decisions to withdraw care). Lastly, these studies have included only a small number of patients with false–positive rates ranging from 0%–22%.…”

Section: Clinical Examinationmentioning

confidence: 99%

Neurologic prognostication after resuscitation from cardiac arrest

2020

View full text Add to dashboard Cite

Out‐of‐hospital cardiac arrest remains a leading cause of mortality in the United States, and the majority of patients who die after achieving return of spontaneous circulation die from withdrawal of care due to a perceived poor neurologic prognosis. Unfortunately, withdrawal of care often occurs during the first day of admission and research suggests this early withdrawal of care may be premature and result in unnecessary deaths for patients who would have made a full neurologic recovery. In this review, we explore the evidence for neurologic prognostication in the emergency department for patients who achieve return of spontaneous circulation after an out‐of‐hospital cardiac arrest.

show abstract

Impact of acute intoxication on quantitative pupillometry assessment in the emergency department

et al. 2022

View full text Add to dashboard Cite

show abstract

Neurological Pupil Index and Pupillary Light Reflex by Pupillometry Predict Outcome Early After Cardiac Arrest

Cited by 81 publications

References 28 publications

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Neurologic prognostication after resuscitation from cardiac arrest

Impact of acute intoxication on quantitative pupillometry assessment in the emergency department

Contact Info

Product

Resources

About