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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

التفاصيل البيبلوغرافية
العنوان: Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients: an international prospective multicenter double-blinded study
المؤلفون: Jean François Payen, John Paul Miroz, Fabio Silvio Taccone, Alain Cariou, Giuseppe Citerio, Janneke Horn, Mauro Oddo, Christian Storm, Claudio Sandroni, Pascal Stammet, Malin Rundgren
المساهمون: Oddo, M, Sandroni, C, Citerio, G, Miroz, J, Horn, J, Rundgren, M, Cariou, A, Payen, J, Storm, C, Stammet, P, Taccone, F, Intensive Care Medicine, ANS - Neuroinfection & -inflammation
المصدر: Intensive care medicine, 44 (12
Intensive care medicine, 44(12), 2102-2111. Springer Verlag
Intensive Care Medicine
Intensive care medicine, vol. 44, no. 12, pp. 2102-2111
بيانات النشر: Springer Verlag, 2018.
سنة النشر: 2018
مصطلحات موضوعية: Male, medicine.medical_specialty, Soins intensifs réanimation, Critical Care, Original, Double blinded, Cardiac arrest, Neurological pupil index, Outcome, Prognostication, Pupillary reactivity, Pupillometry, Critical Care and Intensive Care Medicine, Reflex, Pupillary, Sensitivity and Specificity, Pupil, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Full recovery, Evoked Potentials, Somatosensory, Anesthesiology, Outcome Assessment, Health Care, Settore MED/41 - ANESTESIOLOGIA, mental disorders, Humans, Medicine, Glasgow Coma Scale, Prospective Studies, Pupillary light reflex, Coma, Aged, Pupillometry, Pupillary reactivity, Neurological pupil index, Outcome, Cardiac arrest, Prognostication, business.industry, 030208 emergency & critical care medicine, Middle Aged, Prognosis, humanities, Coma/diagnosis, Coma/etiology, Coma/mortality, Female, Heart Arrest/complications, Heart Arrest/diagnosis, Heart Arrest/mortality, Outcome Assessment (Health Care), Heart Arrest, Multicenter study, Somatosensory evoked potential, Anesthesia, business, 030217 neurology & neurosurgery
الوصف: Purpose: To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA). Methods: 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). Results: 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 < 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)]. Conclusions: Quantitative 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.
SCOPUS: ar.j
info:eu-repo/semantics/published
وصف الملف: 1 full-text file(s): application/pdf; application/pdf
اللغة: English
تدمد: 0342-4642
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::cf5ecc959fe4dac23d75ed6dd986a1f3
http://hdl.handle.net/10281/211608
حقوق: OPEN
رقم الأكسشن: edsair.doi.dedup.....cf5ecc959fe4dac23d75ed6dd986a1f3
قاعدة البيانات: OpenAIRE
الوصف
تدمد:03424642