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

Autor: Peluso L; Department of Biomedical Sciences, Humanitas Huniversity, Pieve Emanuele, Milan, Italy; Department of Anaestesiology and Intensive Care, Humanitas Gavazzeni, Bergamo, Italy; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: lorenzopeluso80@gmail.com., Oddo M; Medical Directorate for Research, Education, Innovation, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland., Minini A; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium., Citerio G; School of Medicine and Surgery, University Milano Bicocca, Neuro-intensive Care Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy., Horn J; Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam Neurosciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands., Di Bernardini E; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium., Rundgren M; Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine, Skåne University Hospital, Lund University, Lund, Sweden., Cariou A; Intensive Care Unit, Hopital Cochin, Paris, France; Paris Descartes University, Paris, France., Payen JF; Department of Anesthesia and Critical Care, Grenoble Alpes University Hospital, Grenoble, France., Storm C; Department of Internal Medicine, Nephrology and Intensive Care, Charité-University, Berlin, Germany., Stammet P; Department of Intensive Care Medicine, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg; Department of Life Sciences and Medicine, Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg., Sandroni C; Department of Intensive Care Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy., Taccone FS; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Jazyk: angličtina
Zdroj: Resuscitation [Resuscitation] 2022 Oct; Vol. 179, pp. 259-266. Date of Electronic Publication: 2022 Jul 30.
DOI: 10.1016/j.resuscitation.2022.07.030
Abstrakt: 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 ABS ); 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, N20 ABS or high NSE had a higher proportion of worst NPi ≤ 2. The accuracy for NPi to predict a discontinuous EEG, N20 ABS , high NSE and the presence of myoclonus was moderate. Concordance with NPi ≤ 2 was high for NSE, and moderate for discontinuous EEG and N20 ABS . 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.
(Copyright © 2022 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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