Heimburger D, Durand M, Gaide-Chevronnay L, et al. Early prediction of coma recovery after cardiac arrest with blinded pupillometry. ![]() Solari D, Rossetti AO, Carteron L, et al. Automated quantitative pupillometry for the prognostication of coma after cardiac arrest. Suys T, Bouzat P, Marques-Vidal P, et al. Infrared pupillometry, the Neurological Pupil index and unilateral pupillary dilation after traumatic brain injury: implications for treatment paradigms. Clinical examination for outcome prediction in nontraumatic coma. Part 4: advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. Practice parameter: Prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Quality Standards Subcommittee of the American Academy of Neurology. Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S. Very early after resuscitation from cardiac arrest, abnormal Neurological Pupil index and pupillary light reflex measurements by pupillometer are predictive of poor outcome, and are not usually associated with dilated pupils. When nonreactive pupils were first detected, 75% were < 5 mm. During TTM, 20/21 (95%) patients with nonreactive pupils had poor outcomes, 9/14 (64%) of patients with sluggish pupils had poor outcomes, and 9/20 (45%) with normal pupil reactivity had poor outcomes. 15/29 (52%) patients with normal pupil reactivity (NPi ≥ 3) had poor outcomes, four survived with cerebral performance category = 3, three died of cardiac causes, and eight died of neurologic causes. ResultsĪll nine patients with ≥ 1 nonreactive pupil (NPi = 0) within 6 (± 2) h after ROSC died, and 12/14 (86%) with sluggish pupils (0 < NPi < 3) had poor outcomes. Prognostic performance to predict poor outcome was assessed with receiver operator characteristic curves. The Neurological Pupil index (NPi) was also determined at each pupil assessment the NPi is scored from 0 (nonreactive) to 5 (brisk) with values < 3 considered sluggish or abnormal. Pupil size, PLR percent constriction (%PLR), and constriction velocity (CV) were determined at TTM start and 6 (± 2)-h post-ROSC (“early”), and throughout TTM using data from the worst eye at each assessment. Discharge outcome was classified good if the cerebral performance category score was 1–2, poor if 3–5. Methodsįifty-five adult patients treated with TTM with available pupillometry data from the NeurOptics NPi-200 were studied. The absence of the pupillary light reflex (PLR) 3 days after cardiac arrest predicts poor outcome, but quantitative PLR assessment with pupillometry early after recovery of spontaneous circulation (ROSC) and throughout targeted temperature management (TTM) has rarely been evaluated.
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