Early prediction of coma recovery after cardiac arrest with blinded pupillometry

Objective Prognostication studies on comatose cardiac arrest (CA) patients are limited by lack of blinding, potentially causing overestimation of outcome predictors and self‐fulfilling prophecy. Using a blinded approach, we analyzed the value of quantitative automated pupillometry to predict neurolo...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Annals of neurology 2017-06, Vol.81 (6), p.804-810
Hauptverfasser: Solari, Daria, Rossetti, Andrea O., Carteron, Laurent, Miroz, John‐Paul, Novy, Jan, Eckert, Philippe, Oddo, Mauro
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 810
container_issue 6
container_start_page 804
container_title Annals of neurology
container_volume 81
creator Solari, Daria
Rossetti, Andrea O.
Carteron, Laurent
Miroz, John‐Paul
Novy, Jan
Eckert, Philippe
Oddo, Mauro
description Objective Prognostication studies on comatose cardiac arrest (CA) patients are limited by lack of blinding, potentially causing overestimation of outcome predictors and self‐fulfilling prophecy. Using a blinded approach, we analyzed the value of quantitative automated pupillometry to predict neurological recovery after CA. Methods We examined a prospective cohort of 103 comatose adult patients who were unconscious 48 hours after CA and underwent repeated measurements of quantitative pupillary light reflex (PLR) using the Neurolight‐Algiscan device. Clinical examination, electroencephalography (EEG), somatosensory evoked potentials (SSEP), and serum neuron‐specific enolase were performed in parallel, as part of standard multimodal assessment. Automated pupillometry results were blinded to clinicians involved in patient care. Cerebral Performance Categories (CPC) at 1 year was the outcome endpoint. Results Survivors (n = 50 patients; 32 CPC 1, 16 CPC 2, 2 CPC 3) had higher quantitative PLR (median = 20 [range = 13–41] vs 11 [0–55] %, p 
doi_str_mv 10.1002/ana.24943
format Article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1895276053</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1895276053</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3533-e5984d6fa3ea6dba74970f26a1c08d8e0a9e3192f3ef50aed982f05af3da719c3</originalsourceid><addsrcrecordid>eNp1kE1L5EAQQBtx0XF2D_4BafCih8xUp_PVx0HcVZDdPei5qemuxpYkHTuJkn9vdNSD4KkoeLwqHmPHAlYCIF1ji6s0U5ncYwuRS5FU87bPFiCLLMmFzA7ZUd8_AIAqBByww7TKSijKfMH-X2KsJ95Fst4MPrQ8OG5CgzySCU8UJ45uoMgNRuvRcIyR-oE_--Geb2vfWrK8Gztf16GhIU4_2Q-HdU-_3ueS3f2-vL24Sm7-_bm-2NwkRuZSJpSrKrOFQ0lY2C2WmSrBpQUKA5WtCFCRFCp1klwOSFZVqYMcnbRYCmXkkp3tvF0Mj-P8km58b6iusaUw9lpUKk_LAuZjS3b6BX0IY2zn77RQQkCZFSqdqfMdZWLo-0hOd9E3GCctQL9m1nNm_ZZ5Zk_ejeO2IftJfnSdgfUOePY1Td-b9ObvZqd8AcDshq8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1911074692</pqid></control><display><type>article</type><title>Early prediction of coma recovery after cardiac arrest with blinded pupillometry</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Solari, Daria ; Rossetti, Andrea O. ; Carteron, Laurent ; Miroz, John‐Paul ; Novy, Jan ; Eckert, Philippe ; Oddo, Mauro</creator><creatorcontrib>Solari, Daria ; Rossetti, Andrea O. ; Carteron, Laurent ; Miroz, John‐Paul ; Novy, Jan ; Eckert, Philippe ; Oddo, Mauro</creatorcontrib><description>Objective Prognostication studies on comatose cardiac arrest (CA) patients are limited by lack of blinding, potentially causing overestimation of outcome predictors and self‐fulfilling prophecy. Using a blinded approach, we analyzed the value of quantitative automated pupillometry to predict neurological recovery after CA. Methods We examined a prospective cohort of 103 comatose adult patients who were unconscious 48 hours after CA and underwent repeated measurements of quantitative pupillary light reflex (PLR) using the Neurolight‐Algiscan device. Clinical examination, electroencephalography (EEG), somatosensory evoked potentials (SSEP), and serum neuron‐specific enolase were performed in parallel, as part of standard multimodal assessment. Automated pupillometry results were blinded to clinicians involved in patient care. Cerebral Performance Categories (CPC) at 1 year was the outcome endpoint. Results Survivors (n = 50 patients; 32 CPC 1, 16 CPC 2, 2 CPC 3) had higher quantitative PLR (median = 20 [range = 13–41] vs 11 [0–55] %, p &lt; 0.0001) and constriction velocity (1.46 [0.85–4.63] vs 0.94 [0.16–4.97] mm/s, p &lt; 0.0001) than nonsurvivors. At 48 hours, a quantitative PLR &lt; 13% had 100% specificity and positive predictive value to predict poor recovery (0% false‐positive rate), and provided equal performance to that of EEG and SSEP. Reduced quantitative PLR correlated with higher serum neuron‐specific enolase (Spearman r = −0.52, p &lt; 0.0001). Interpretation Reduced quantitative PLR correlates with postanoxic brain injury and, when compared to standard multimodal assessment, is highly accurate in predicting long‐term prognosis after CA. This is the first prognostication study to show the value of automated pupillometry using a blinded approach to minimize self‐fulfilling prophecy. Ann Neurol 2017;81:804–810</description><identifier>ISSN: 0364-5134</identifier><identifier>EISSN: 1531-8249</identifier><identifier>DOI: 10.1002/ana.24943</identifier><identifier>PMID: 28470675</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Brain ; Brain injury ; Cardiac arrest ; Categories ; Coma ; Coma - blood ; Coma - diagnosis ; Coma - etiology ; Coma - physiopathology ; EEG ; Electroencephalography ; Evoked potentials ; Evoked Potentials, Somatosensory ; Female ; Follow-Up Studies ; Head injuries ; Heart ; Heart Arrest - complications ; Heart attacks ; Heart diseases ; Humans ; Infrared Rays ; Injury prevention ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Patients ; Persistent vegetative state ; Phosphopyruvate hydratase ; Phosphopyruvate Hydratase - blood ; Predictions ; Predictive Value of Tests ; Prognosis ; Pupil - physiology ; Pupillometry ; Recovery ; Reflex, Pupillary - physiology ; Severity of Illness Index ; Single-Blind Method ; Somatosensory evoked potentials ; Velocity</subject><ispartof>Annals of neurology, 2017-06, Vol.81 (6), p.804-810</ispartof><rights>2017 American Neurological Association</rights><rights>2017 American Neurological Association.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3533-e5984d6fa3ea6dba74970f26a1c08d8e0a9e3192f3ef50aed982f05af3da719c3</citedby><cites>FETCH-LOGICAL-c3533-e5984d6fa3ea6dba74970f26a1c08d8e0a9e3192f3ef50aed982f05af3da719c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fana.24943$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fana.24943$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28470675$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Solari, Daria</creatorcontrib><creatorcontrib>Rossetti, Andrea O.</creatorcontrib><creatorcontrib>Carteron, Laurent</creatorcontrib><creatorcontrib>Miroz, John‐Paul</creatorcontrib><creatorcontrib>Novy, Jan</creatorcontrib><creatorcontrib>Eckert, Philippe</creatorcontrib><creatorcontrib>Oddo, Mauro</creatorcontrib><title>Early prediction of coma recovery after cardiac arrest with blinded pupillometry</title><title>Annals of neurology</title><addtitle>Ann Neurol</addtitle><description>Objective Prognostication studies on comatose cardiac arrest (CA) patients are limited by lack of blinding, potentially causing overestimation of outcome predictors and self‐fulfilling prophecy. Using a blinded approach, we analyzed the value of quantitative automated pupillometry to predict neurological recovery after CA. Methods We examined a prospective cohort of 103 comatose adult patients who were unconscious 48 hours after CA and underwent repeated measurements of quantitative pupillary light reflex (PLR) using the Neurolight‐Algiscan device. Clinical examination, electroencephalography (EEG), somatosensory evoked potentials (SSEP), and serum neuron‐specific enolase were performed in parallel, as part of standard multimodal assessment. Automated pupillometry results were blinded to clinicians involved in patient care. Cerebral Performance Categories (CPC) at 1 year was the outcome endpoint. Results Survivors (n = 50 patients; 32 CPC 1, 16 CPC 2, 2 CPC 3) had higher quantitative PLR (median = 20 [range = 13–41] vs 11 [0–55] %, p &lt; 0.0001) and constriction velocity (1.46 [0.85–4.63] vs 0.94 [0.16–4.97] mm/s, p &lt; 0.0001) than nonsurvivors. At 48 hours, a quantitative PLR &lt; 13% had 100% specificity and positive predictive value to predict poor recovery (0% false‐positive rate), and provided equal performance to that of EEG and SSEP. Reduced quantitative PLR correlated with higher serum neuron‐specific enolase (Spearman r = −0.52, p &lt; 0.0001). Interpretation Reduced quantitative PLR correlates with postanoxic brain injury and, when compared to standard multimodal assessment, is highly accurate in predicting long‐term prognosis after CA. This is the first prognostication study to show the value of automated pupillometry using a blinded approach to minimize self‐fulfilling prophecy. Ann Neurol 2017;81:804–810</description><subject>Aged</subject><subject>Brain</subject><subject>Brain injury</subject><subject>Cardiac arrest</subject><subject>Categories</subject><subject>Coma</subject><subject>Coma - blood</subject><subject>Coma - diagnosis</subject><subject>Coma - etiology</subject><subject>Coma - physiopathology</subject><subject>EEG</subject><subject>Electroencephalography</subject><subject>Evoked potentials</subject><subject>Evoked Potentials, Somatosensory</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Head injuries</subject><subject>Heart</subject><subject>Heart Arrest - complications</subject><subject>Heart attacks</subject><subject>Heart diseases</subject><subject>Humans</subject><subject>Infrared Rays</subject><subject>Injury prevention</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Outcome Assessment (Health Care)</subject><subject>Patients</subject><subject>Persistent vegetative state</subject><subject>Phosphopyruvate hydratase</subject><subject>Phosphopyruvate Hydratase - blood</subject><subject>Predictions</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Pupil - physiology</subject><subject>Pupillometry</subject><subject>Recovery</subject><subject>Reflex, Pupillary - physiology</subject><subject>Severity of Illness Index</subject><subject>Single-Blind Method</subject><subject>Somatosensory evoked potentials</subject><subject>Velocity</subject><issn>0364-5134</issn><issn>1531-8249</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1L5EAQQBtx0XF2D_4BafCih8xUp_PVx0HcVZDdPei5qemuxpYkHTuJkn9vdNSD4KkoeLwqHmPHAlYCIF1ji6s0U5ncYwuRS5FU87bPFiCLLMmFzA7ZUd8_AIAqBByww7TKSijKfMH-X2KsJ95Fst4MPrQ8OG5CgzySCU8UJ45uoMgNRuvRcIyR-oE_--Geb2vfWrK8Gztf16GhIU4_2Q-HdU-_3ueS3f2-vL24Sm7-_bm-2NwkRuZSJpSrKrOFQ0lY2C2WmSrBpQUKA5WtCFCRFCp1klwOSFZVqYMcnbRYCmXkkp3tvF0Mj-P8km58b6iusaUw9lpUKk_LAuZjS3b6BX0IY2zn77RQQkCZFSqdqfMdZWLo-0hOd9E3GCctQL9m1nNm_ZZ5Zk_ejeO2IftJfnSdgfUOePY1Td-b9ObvZqd8AcDshq8</recordid><startdate>201706</startdate><enddate>201706</enddate><creator>Solari, Daria</creator><creator>Rossetti, Andrea O.</creator><creator>Carteron, Laurent</creator><creator>Miroz, John‐Paul</creator><creator>Novy, Jan</creator><creator>Eckert, Philippe</creator><creator>Oddo, Mauro</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201706</creationdate><title>Early prediction of coma recovery after cardiac arrest with blinded pupillometry</title><author>Solari, Daria ; Rossetti, Andrea O. ; Carteron, Laurent ; Miroz, John‐Paul ; Novy, Jan ; Eckert, Philippe ; Oddo, Mauro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3533-e5984d6fa3ea6dba74970f26a1c08d8e0a9e3192f3ef50aed982f05af3da719c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Brain</topic><topic>Brain injury</topic><topic>Cardiac arrest</topic><topic>Categories</topic><topic>Coma</topic><topic>Coma - blood</topic><topic>Coma - diagnosis</topic><topic>Coma - etiology</topic><topic>Coma - physiopathology</topic><topic>EEG</topic><topic>Electroencephalography</topic><topic>Evoked potentials</topic><topic>Evoked Potentials, Somatosensory</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Head injuries</topic><topic>Heart</topic><topic>Heart Arrest - complications</topic><topic>Heart attacks</topic><topic>Heart diseases</topic><topic>Humans</topic><topic>Infrared Rays</topic><topic>Injury prevention</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Outcome Assessment (Health Care)</topic><topic>Patients</topic><topic>Persistent vegetative state</topic><topic>Phosphopyruvate hydratase</topic><topic>Phosphopyruvate Hydratase - blood</topic><topic>Predictions</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Pupil - physiology</topic><topic>Pupillometry</topic><topic>Recovery</topic><topic>Reflex, Pupillary - physiology</topic><topic>Severity of Illness Index</topic><topic>Single-Blind Method</topic><topic>Somatosensory evoked potentials</topic><topic>Velocity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Solari, Daria</creatorcontrib><creatorcontrib>Rossetti, Andrea O.</creatorcontrib><creatorcontrib>Carteron, Laurent</creatorcontrib><creatorcontrib>Miroz, John‐Paul</creatorcontrib><creatorcontrib>Novy, Jan</creatorcontrib><creatorcontrib>Eckert, Philippe</creatorcontrib><creatorcontrib>Oddo, Mauro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Solari, Daria</au><au>Rossetti, Andrea O.</au><au>Carteron, Laurent</au><au>Miroz, John‐Paul</au><au>Novy, Jan</au><au>Eckert, Philippe</au><au>Oddo, Mauro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early prediction of coma recovery after cardiac arrest with blinded pupillometry</atitle><jtitle>Annals of neurology</jtitle><addtitle>Ann Neurol</addtitle><date>2017-06</date><risdate>2017</risdate><volume>81</volume><issue>6</issue><spage>804</spage><epage>810</epage><pages>804-810</pages><issn>0364-5134</issn><eissn>1531-8249</eissn><abstract>Objective Prognostication studies on comatose cardiac arrest (CA) patients are limited by lack of blinding, potentially causing overestimation of outcome predictors and self‐fulfilling prophecy. Using a blinded approach, we analyzed the value of quantitative automated pupillometry to predict neurological recovery after CA. Methods We examined a prospective cohort of 103 comatose adult patients who were unconscious 48 hours after CA and underwent repeated measurements of quantitative pupillary light reflex (PLR) using the Neurolight‐Algiscan device. Clinical examination, electroencephalography (EEG), somatosensory evoked potentials (SSEP), and serum neuron‐specific enolase were performed in parallel, as part of standard multimodal assessment. Automated pupillometry results were blinded to clinicians involved in patient care. Cerebral Performance Categories (CPC) at 1 year was the outcome endpoint. Results Survivors (n = 50 patients; 32 CPC 1, 16 CPC 2, 2 CPC 3) had higher quantitative PLR (median = 20 [range = 13–41] vs 11 [0–55] %, p &lt; 0.0001) and constriction velocity (1.46 [0.85–4.63] vs 0.94 [0.16–4.97] mm/s, p &lt; 0.0001) than nonsurvivors. At 48 hours, a quantitative PLR &lt; 13% had 100% specificity and positive predictive value to predict poor recovery (0% false‐positive rate), and provided equal performance to that of EEG and SSEP. Reduced quantitative PLR correlated with higher serum neuron‐specific enolase (Spearman r = −0.52, p &lt; 0.0001). Interpretation Reduced quantitative PLR correlates with postanoxic brain injury and, when compared to standard multimodal assessment, is highly accurate in predicting long‐term prognosis after CA. This is the first prognostication study to show the value of automated pupillometry using a blinded approach to minimize self‐fulfilling prophecy. Ann Neurol 2017;81:804–810</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28470675</pmid><doi>10.1002/ana.24943</doi><tpages>7</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0364-5134
ispartof Annals of neurology, 2017-06, Vol.81 (6), p.804-810
issn 0364-5134
1531-8249
language eng
recordid cdi_proquest_miscellaneous_1895276053
source MEDLINE; Wiley Online Library Journals Frontfile Complete
subjects Aged
Brain
Brain injury
Cardiac arrest
Categories
Coma
Coma - blood
Coma - diagnosis
Coma - etiology
Coma - physiopathology
EEG
Electroencephalography
Evoked potentials
Evoked Potentials, Somatosensory
Female
Follow-Up Studies
Head injuries
Heart
Heart Arrest - complications
Heart attacks
Heart diseases
Humans
Infrared Rays
Injury prevention
Male
Middle Aged
Outcome Assessment (Health Care)
Patients
Persistent vegetative state
Phosphopyruvate hydratase
Phosphopyruvate Hydratase - blood
Predictions
Predictive Value of Tests
Prognosis
Pupil - physiology
Pupillometry
Recovery
Reflex, Pupillary - physiology
Severity of Illness Index
Single-Blind Method
Somatosensory evoked potentials
Velocity
title Early prediction of coma recovery after cardiac arrest with blinded pupillometry
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T15%3A47%3A00IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Early%20prediction%20of%20coma%20recovery%20after%20cardiac%20arrest%20with%20blinded%20pupillometry&rft.jtitle=Annals%20of%20neurology&rft.au=Solari,%20Daria&rft.date=2017-06&rft.volume=81&rft.issue=6&rft.spage=804&rft.epage=810&rft.pages=804-810&rft.issn=0364-5134&rft.eissn=1531-8249&rft_id=info:doi/10.1002/ana.24943&rft_dat=%3Cproquest_cross%3E1895276053%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1911074692&rft_id=info:pmid/28470675&rfr_iscdi=true