Automated Quantitative Pupillometry for the Prognostication of Coma After Cardiac Arrest

Background Sedation and therapeutic hypothermia (TH) delay neurological responses and might reduce the accuracy of clinical examination to predict outcome after cardiac arrest (CA). We examined the accuracy of quantitative pupillary light reactivity (PLR), using an automated infrared pupillometry, t...

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Bibliographic Details
Published in:Neurocritical care 2014-10, Vol.21 (2), p.300-308
Main Authors: Suys, Tamarah, Bouzat, Pierre, Marques-Vidal, Pedro, Sala, Nathalie, Payen, Jean-François, Rossetti, Andrea O., Oddo, Mauro
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Algorithms
Anesthesia
Automation
Cardiac arrest
Coma
Coma - diagnosis
Coma - etiology
Coma - therapy
Critical Care Medicine
Electroencephalography
Female
Heart Arrest - complications
Humans
Hypnotics and Sedatives - therapeutic use
Hypothermia
Infrared Rays
Intensive
Internal Medicine
Male
Medical prognosis
Medicine
Medicine & Public Health
Middle Aged
Neurology
Original Article
Patients
Predictive Value of Tests
Prognosis
Prospective Studies
Reflex, Pupillary - physiology
Regression analysis
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Summary:Background Sedation and therapeutic hypothermia (TH) delay neurological responses and might reduce the accuracy of clinical examination to predict outcome after cardiac arrest (CA). We examined the accuracy of quantitative pupillary light reactivity (PLR), using an automated infrared pupillometry, to predict outcome of post-CA coma in comparison to standard PLR, EEG, and somato-sensory evoked potentials (SSEP). Methods We prospectively studied over a 1-year period (June 2012–June 2013) 50 consecutive comatose CA patients treated with TH (33 °C, 24 h). Quantitative PLR (expressed as the % of pupillary response to a calibrated light stimulus) and standard PLR were measured at day 1 (TH and sedation; on average 16 h after CA) and day 2 (normothermia, off sedation: on average 46 h after CA). Neurological outcome was assessed at 90 days with Cerebral Performance Categories (CPC), dichotomized as good (CPC 1–2) versus poor (CPC 3–5). Predictive performance was analyzed using area under the ROC curves (AUC). Results Patients with good outcome [ n  = 23 (46 %)] had higher quantitative PLR than those with poor outcome [ n  = 27; 16 (range 9–23) vs. 10 (1–30) % at day 1, and 20 (13–39) vs. 11 (1–55) % at day 2, both p  
ISSN:1541-6933
1556-0961
DOI:10.1007/s12028-014-9981-z