Quantitative pupillometry and transcranial Doppler measurements in patients treated with hypothermia after cardiac arrest
Quantitative pupillometry and transcranial Doppler measurements in patients treated with hypothermia after cardiac arrest
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DOI：
10.1016/j.resuscitation.2016.02.026
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发表时间：
2016-06-01
期刊：
影响因子：
6.5
通讯作者：
Payen, Jean-Francois
中科院分区：
文献类型：
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作者：
Heimburger, Delphine;Durand, Michel;Payen, Jean-Francois
背景：当使用治疗性低温(TH)时，预测心脏骤停(CA)后的预后尤其困难。我们研究了定量瞳孔测量和经颅多普勒(TCD)的表现。方法：这项前瞻性观察研究包括82例CA术后患者。在入院时(第1天)和入院后24小时(第2天)(33~35天)分别进行双侧大脑中动脉瞳孔光反射(PLR)和经颅多普勒(TCD)测量。摄氏度)和镇静。3个月后用脑功能分类(CPC)评分评估神经预后；将患者分为预后良好(CPC 1-2)或预后差(CPC 3-5)。结果：预后良好的患者(n=27)在第1天、13%(10-18)(中位数，第25-75百分位数)和第2天(17%(13-20)和8%(5-13))的P<；波幅分别高于预后差的患者(n=55)和17%(13-20)和8%(P<；0.001)。第1天和第2天的AUC-ROC曲线分别为0.76(95%可信区间0.65~0.86)和0.82(95%可信区间0.73~0.92)。预测3个月不良预后的PLR波幅的最佳临界值分别为<；9%和<；11%。第2天PLR波幅<7%预测3个月不良预后，其特异度为100%(95%可信区间86-100)，灵敏度为42%(95%可信区间28-58)。两组患者之间的TCD测量没有差异。结论：PLR测量可能有助于预测CA术后患者的预后，即使在镇静和低温下也是如此。(C)2016爱思唯尔爱尔兰有限公司。保留所有权利。
Background: Predicting outcome after cardiac arrest (CA) is particularly difficult when therapeutic hypothermia (TH) is used. We investigated the performance of quantitative pupillometry and transcranial Doppler (TCD) in this context.Methods: This prospective observational study included 82 post-CA patients. Quantitative assessment of pupillary light reflex (PLR) and TCD measurements of the two middle cerebral arteries were performed at admission (day 1) and after 24 h (day 2) during TH (33-35. degrees C) and sedation. Neurological outcome was assessed at 3 months using cerebral performance category (CPC) scores; patients were classified as having good (CPC 1-2) or poor (CPC 3-5) outcome. Prognostic performance was analyzed using area under the receiver operating characteristic curve (AUC-ROC).Results: Patients with good outcome (n = 27) had higher PLR amplitude than patients with poor outcome (n = 55) both at day 1, 13% (10-18) (median, 25th-75th percentile) vs. 8% (2-11) (P < 0.001), and at day 2, 17% (13-20) vs. 8% (5-13) (P < 0.001), respectively. The AUC-ROC curves at days 1 and 2 were 0.76 (95% confidence interval [CI] 0.65-0.86) and 0.82 (95% CI 0.73-0.92), respectively. The best cut-off values of PLR amplitude to predict a 3-month poor outcome were < 9% and < 11%, respectively. A PLR amplitude of < 7% at day 2 predicted a 3-month poor outcome with a specificity of 100% (95% CI 86-100) and a sensitivity of 42% (95% CI 28-58). No differences in TCD measurements were found between the two patient groups.Conclusion: PLR measurements might be informative in the prediction of outcome of post-CA patients even under sedation and hypothermia. (C) 2016 Elsevier Ireland Ltd. All rights reserved.