Prognostic performance of early absence of pupillary light reaction after recovery of out of hospital cardiac arrest

Javaudin, François; Leclère, Brice; Segard, Julien; Bastard, Quentin Le; Pès, Philippe; Penverne, Yann; Conte, Philippe Le; Jenvrin, J.; Hubert, Hervé; Escutnaire, Joséphine; Batard, Éric; Montassier, Emmanuel; GR-RéAC,

doi:10.1016/j.resuscitation.2018.03.020

Cited by 33 publications

(18 citation statements)

References 20 publications

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“…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%

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

et al. 2020

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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

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: And Esm Fig 3)mentioning

confidence: 99%

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

et al. 2020

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“…Despite a high specificity for predicting a poor neurological outcome, its sensitivity is low ( 27 – 29 ). Consequently, pupillary light reactivity alone is not sufficiently accurate to determine the prognosis and the decision making ( 30 – 32 ). In this perspective, the clinical management of out-of-hospital CA, as previously described in the literature ( 33 , 34 ), should be re-evaluated taking into account the recent progress made in the treatment of CA ( 18 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

Pupil Reactivity in Refractory Out-ofHospital Cardiac Arrest Treated by ExtraCorporeal Cardiopulmonary Resuscitation

Jouffroy

Saade

Pelletier

et al. 2020

Turk J Anaesthesiol Reanim

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“…60,61 For example, a recent study of >10,000 post-arrest patients in France showed that 64% had nonreactive pupils on presentation, of whom 10% enjoyed favorable recoveries. 62 A core temperature, preferably esophageal or bladder, may reveal accidental hypothermic cardiac arrest. These patients require a fundamentally different treatment strategy and can have a survival rate >70% despite initial moribund appearance.…”

Section: Physical Examinationmentioning

confidence: 99%

Early risk stratification after resuscitation from cardiac arrest

et al. 2020

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Emergency clinicians often resuscitate cardiac arrest patients, and after acute resuscitation, clinicians face multiple decisions regarding disposition. Recent evidence suggests that out‐of‐hospital cardiac arrest patients with return of spontaneous circulation have higher odds of survival to hospital discharge, long‐term survival, and improved functional outcomes when treated at centers that can provide advanced multidisciplinary care. For community clinicians, a high volume cardiac arrest center may be hours away. While current guidelines recommend against neurological prognostication in the first hours or days after return of spontaneous circulation, there are early findings suggestive of irrecoverable brain injury in which the patient would receive no benefit from transfer. In this Concepts article, we describe a simplified approach to quickly evaluate neurological status in cardiac arrest patients and identify findings concerning for irrecoverable brain injury. Characteristics of the arrest and resuscitation, initial neurological assessment, and brain computed tomography together can identify patients with high likelihood of irrecoverable anoxic injury. Patients who may benefit from centers with access to continuous electroencephalography are discussed. This approach can be used to identify patients who may benefit from rapid transfer to cardiac arrest centers versus those who may benefit from care close to home. Risk stratification also can provide realistic expectations for recovery to families.

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Prognostic performance of early absence of pupillary light reaction after recovery of out of hospital cardiac arrest

Cited by 33 publications

References 20 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

Pupil Reactivity in Refractory Out-ofHospital Cardiac Arrest Treated by ExtraCorporeal Cardiopulmonary Resuscitation

Early risk stratification after resuscitation from cardiac arrest

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