Early outcome prediction with quantitative pupillary response parameters after out-of-hospital cardiac arrest: A multicenter prospective observational study​

Tomoyoshi Tamura; Jun Namiki; Yoko Sugawara; Kazuhiko Sekine; Kikuo Yo; Takahiro Kanaya; Shoji Yokobori; Takayuki Abe; Hiroyuki Yokota; Junichi Sasaki

doi:10.1371/journal.pone.0228224

Early outcome prediction with quantitative pupillary response parameters after out-of-hospital cardiac arrest: A multicenter prospective observational study

PLoS One. 2020 Mar 19;15(3):e0228224. doi: 10.1371/journal.pone.0228224. eCollection 2020.

Authors

Tomoyoshi Tamura¹, Jun Namiki^{1

2}, Yoko Sugawara³, Kazuhiko Sekine³, Kikuo Yo⁴, Takahiro Kanaya⁵, Shoji Yokobori⁵, Takayuki Abe⁶, Hiroyuki Yokota⁵, Junichi Sasaki¹

Affiliations

¹ Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.
² Department of Emergency Medicine, KKR Tachikawa Hospital, Tokyo, Japan.
³ Department of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
⁴ Department of Emergency and Critical Care Medicine, Hiratsuka City Hospital, Kanagawa, Japan.
⁵ Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
⁶ Clinical and Translational Research Center, Keio University, Tokyo, Japan.

Abstract

We aimed to determine the characteristics of quantitative pupillary response parameters other than amplitude of pupillary light reflex (PLR) early after return of spontaneous circulation (ROSC) and their implications for predicting neurological outcomes early after cardiac arrest (CA). Fifty adults resuscitated after non-traumatic out-of-hospital CA from four emergency hospitals were enrolled. Pupil diameters, PLR, constriction velocity (CV), maximum CV (MCV), dilation velocity (DV), latency of constriction, and Neurological Pupil index (NPi) were quantitatively measured at 0, 6, 12, 24, 48, and 72 h post-ROSC using an automated pupillometer. Change over time of each parameter was compared between favorable (Cerebral Performance Category [CPC] 1 or 2) and unfavorable neurological outcome (CPC 3-5) groups. Prognostic values of 90-day favorable outcome by these parameters and when combined with clinical predictors (witness status, bystander cardiopulmonary resuscitation, initial shockable rhythm, implementation of target temperature management) were tested. Thirteen patients achieved favorable outcome. CV, MCV, DV (P < 0.001), and NPi (P = 0.005) were consistently greater in the favorable group than in the unfavorable outcome group. Change over time was not statistically different between the groups in all parameters. CV, MCV, DV (ρ = 0.96 to 0.97, P < 0.001, respectively), and NPi (ρ = 0.65, P < 0.001) positively correlated with PLR. The prognostic value of 0-hour CV (area under the curve, AUC [95% confidence interval]: 0.92 [0.80-1.00]), DV (0.84 [0.68-0.99]), and NPi (0.88 [0.74-1.00]) was equivalent to that of PLR (0.84 [0.69-0.98]). Prognostic values improved to AUC of 0.95-0.96 when 0-hour PLR, CV, DV, or NPi was combined with clinical predictors. The 0-hour CV, MCV, and NPi showed equivalent prognostic values to PLR alone/in combination with clinical predictors. Using PLR among several quantitative pupillary response parameters for early neurological prognostication of post-CA patients is a simple and effective strategy.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Female
Humans
Male
Middle Aged
Neurology
Out-of-Hospital Cardiac Arrest / diagnosis*
Out-of-Hospital Cardiac Arrest / physiopathology*
Prognosis
Prospective Studies
Pupil / physiology*

Grants and funding

JN received grant from Japan Society for the Promotion of Science (KAKENHI 15H05009; https://www.jsps.go.jp/english/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.