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Neurological pupil index and its association with other prognostic tools after cardiac arrest : A post hoc analysis

Peluso, Lorenzo ; Oddo, Mauro ; Minini, Andrea ; Citerio, Giuseppe ; Horn, Janneke ; Di Bernardini, Eugenio ; Rundgren, Malin LU ; Cariou, Alain ; Payen, Jean Francois and Storm, Christian , et al. (2022) In Resuscitation 179. p.259-266
Abstract

Introduction: We evaluated the concordance of the Neurological pupil Index (NPi) with other predictors of outcome after cardiac arrest (CA). Methods: Post hoc analysis of a prospective, international, multicenter study including adult CA patients. Predictors of unfavorable outcome (UO, Cerebral Performance Category of 3–5 at 3 months) included: a) worst NPi ≤ 2; b) presence of discontinuous encephalography (EEG) background; c) bilateral absence of N20 waves on somatosensory evoked potentials (N20ABS); d) peak neuron-specific enolase (NSE) blood levels > 60 mcg/L; e) myoclonus, which were all tested in a subset of patients who underwent complete multimodal assessment (MMM). Results: A total of 269/456 (59 %) patients had UO... (More)

Introduction: We evaluated the concordance of the Neurological pupil Index (NPi) with other predictors of outcome after cardiac arrest (CA). Methods: Post hoc analysis of a prospective, international, multicenter study including adult CA patients. Predictors of unfavorable outcome (UO, Cerebral Performance Category of 3–5 at 3 months) included: a) worst NPi ≤ 2; b) presence of discontinuous encephalography (EEG) background; c) bilateral absence of N20 waves on somatosensory evoked potentials (N20ABS); d) peak neuron-specific enolase (NSE) blood levels > 60 mcg/L; e) myoclonus, which were all tested in a subset of patients who underwent complete multimodal assessment (MMM). Results: A total of 269/456 (59 %) patients had UO and 186 (41 %) underwent MMM. The presence of myoclonus was assessed in all patients, EEG in 358 (78 %), N20 in 186 (41 %) and NSE measurement in 228 (50 %). Patients with discontinuous EEG, N20ABS or high NSE had a higher proportion of worst NPi ≤ 2. The accuracy for NPi to predict a discontinuous EEG, N20ABS, high NSE and the presence of myoclonus was moderate. Concordance with NPi ≤ 2 was high for NSE, and moderate for discontinuous EEG and N20ABS. Also, the higher the number of concordant predictors of poor outcome, the lower the observed NPi. Conclusions: In this study, NPi ≤ 2 had moderate to high concordance with other unfavorable outcome prognosticators of hypoxic-ischemic brain injury. This indicates that NPi measurement could be considered as a valid tool for coma prognostication after cardiac arrest.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Automated pupillometer, Automated pupillometry, Brain injury, Concordance, Heart arrest, Prognosis
in
Resuscitation
volume
179
pages
8 pages
publisher
Elsevier
external identifiers
  • pmid:35914656
  • scopus:85135504515
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2022.07.030
language
English
LU publication?
yes
id
a7065962-5b32-46c3-8a91-f091948e61b6
date added to LUP
2022-11-02 14:38:03
date last changed
2024-04-18 10:09:12
@article{a7065962-5b32-46c3-8a91-f091948e61b6,
  abstract     = {{<p>Introduction: We evaluated the concordance of the Neurological pupil Index (NPi) with other predictors of outcome after cardiac arrest (CA). Methods: Post hoc analysis of a prospective, international, multicenter study including adult CA patients. Predictors of unfavorable outcome (UO, Cerebral Performance Category of 3–5 at 3 months) included: a) worst NPi ≤ 2; b) presence of discontinuous encephalography (EEG) background; c) bilateral absence of N20 waves on somatosensory evoked potentials (N20<sub>ABS</sub>); d) peak neuron-specific enolase (NSE) blood levels &gt; 60 mcg/L; e) myoclonus, which were all tested in a subset of patients who underwent complete multimodal assessment (MMM). Results: A total of 269/456 (59 %) patients had UO and 186 (41 %) underwent MMM. The presence of myoclonus was assessed in all patients, EEG in 358 (78 %), N20 in 186 (41 %) and NSE measurement in 228 (50 %). Patients with discontinuous EEG, N20<sub>ABS</sub> or high NSE had a higher proportion of worst NPi ≤ 2. The accuracy for NPi to predict a discontinuous EEG, N20<sub>ABS</sub>, high NSE and the presence of myoclonus was moderate. Concordance with NPi ≤ 2 was high for NSE, and moderate for discontinuous EEG and N20<sub>ABS</sub>. Also, the higher the number of concordant predictors of poor outcome, the lower the observed NPi. Conclusions: In this study, NPi ≤ 2 had moderate to high concordance with other unfavorable outcome prognosticators of hypoxic-ischemic brain injury. This indicates that NPi measurement could be considered as a valid tool for coma prognostication after cardiac arrest.</p>}},
  author       = {{Peluso, Lorenzo and Oddo, Mauro and Minini, Andrea and Citerio, Giuseppe and Horn, Janneke and Di Bernardini, Eugenio and Rundgren, Malin and Cariou, Alain and Payen, Jean Francois and Storm, Christian and Stammet, Pascal and Sandroni, Claudio and Taccone, Fabio Silvio}},
  issn         = {{0300-9572}},
  keywords     = {{Automated pupillometer; Automated pupillometry; Brain injury; Concordance; Heart arrest; Prognosis}},
  language     = {{eng}},
  pages        = {{259--266}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Neurological pupil index and its association with other prognostic tools after cardiac arrest : A post hoc analysis}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2022.07.030}},
  doi          = {{10.1016/j.resuscitation.2022.07.030}},
  volume       = {{179}},
  year         = {{2022}},
}