Automated Quantitative Pupillometry for the Prognostication of Coma After Cardiac Arrest
- PDF / 510,876 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 89 Downloads / 189 Views
ORIGINAL ARTICLE
Automated Quantitative Pupillometry for the Prognostication of Coma After Cardiac Arrest Tamarah Suys • Pierre Bouzat • Pedro Marques-Vidal Nathalie Sala • Jean-Franc¸ois Payen • Andrea O. Rossetti • Mauro Oddo
•
Ó Springer Science+Business Media New York 2014
Abstract 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
Tamarah Suys and Pierre Bouzat contributed equally. T. Suys P. Bouzat N. Sala M. Oddo (&) Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University Hospital and Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland e-mail: [email protected] P. Bouzat J.-F. Payen Department of Anesthesiology and Intensive Care Medicine, Grenoble University Hospital and Joseph Fourier University, Grenoble, France P. Marques-Vidal Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland A. O. Rossetti Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), University Hospital and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
(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 < 0.001]. Best cut-off for outcome prediction of quantitative PLR was 0.20). Conclusions Quantitative PLR is more accurate than standard PLR in predicting outcome of post-anoxic coma, irrespective of temperature and sedation, and has comparable prognostic accuracy than EEG and SSEP. Keywords Cardiac arrest Therapeutic hypothermia Outcome Coma Prognosis Pupillometry Pupillary light reactivity Pupillary response EEG Evoked potentials
Introduction Implementation of post-resuscitation care and therapeutic hypothermia (TH) has significantly increased the number of
123
Neurocrit Care
Data Loading...
