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...
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Veröffentlicht in: | Annals of neurology 2017-06, Vol.81 (6), p.804-810 |
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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 |
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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 < 0.0001) and constriction velocity (1.46 [0.85–4.63] vs 0.94 [0.16–4.97] mm/s, p < 0.0001) than nonsurvivors. At 48 hours, a quantitative PLR < 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 < 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 < 0.0001) and constriction velocity (1.46 [0.85–4.63] vs 0.94 [0.16–4.97] mm/s, p < 0.0001) than nonsurvivors. At 48 hours, a quantitative PLR < 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 < 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 & 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 < 0.0001) and constriction velocity (1.46 [0.85–4.63] vs 0.94 [0.16–4.97] mm/s, p < 0.0001) than nonsurvivors. At 48 hours, a quantitative PLR < 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 < 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> |
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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 |
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