Quantitative assessment of pupillary light reflex for early prediction of outcomes after out-of-hospital cardiac arrest: A multicentre prospective observational study
Quantitative assessment of pupillary light reflex for early prediction of outcomes after out-of-hospital cardiac arrest: A multicentre prospective observational study
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DOI：
10.1016/j.resuscitation.2018.06.027
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发表时间：
2018-10-01
期刊：
影响因子：
6.5
通讯作者：
Sasaki, Junichi
中科院分区：
文献类型：
--
作者：
Tamura, Tomoyoshi;Namiki, Jun;Sasaki, Junichi
目的：阐明瞳孔对光反射 (PLR) 的定量评估是否可以预测心脏骤停后 (CA) 患者自主循环 (ROSC) 恢复后最初 72 小时内的结果。 方法：在四家急救医院招募了 50 名非外伤性院外 CA (OHCA) 复苏成人（平均年龄 64.1 岁，36 名男性）。通过自动便携式红外瞳孔测量仪在 ROSC 后 0、6、12、24、48 和 72 小时依次测量 PLR。比较幸存者和非幸存者以及具有有利（大脑性能类别 (CPC) 1 或 2）或不利神经学结果的患者之间每个时间点的 PLR 值。 结果：23 名患者在 CA 后存活了 90 天，其中 13 名患者获得了良好的神经学结果。幸存者和具有良好神经学结果的患者的 PLR 值始终分别高于非幸存者 (P < 0.001) 和具有不良神经学结果的患者 (P < 0.001)。结果组之间 PLR 随时间的变化没有统计学差异。 0 小时 PLR 能够最好地预测 90 天生存率（AUC = 0.82，截止值 3%，敏感性 0.87，特异性 0.80）和良好的神经学结果（AUC = 0.84，截止值 6%，敏感性 0.92，特异性 0.74）。 6 小时 PLR 低于 3% 的患者在 CA 后没有存活 90 天。结论：在 ROSC 后 72 小时内，幸存者和具有良好神经学结果的患者的定量测量的 PLR 始终较高。早在 0 小时对 PLR 进行定量评估对于 CA 后患者的预后具有潜在作用。
Aim: To clarify whether quantitative assessment of pupillary light reflexes (PLR) can predict the outcome of post-cardiac arrest (CA) patients during the first 72 h after the return of spontaneous circulation (ROSC).Methods: Fifty adults resuscitated after non-traumatic out-of-hospital CA (OHCA) (mean age 64.1 years old, 36 males) were enrolled in four emergency hospitals. PLR was sequentially measured at 0, 6, 12, 24, 48, and 72 h after ROSC by an automated portable infrared pupillometry. PLR values for each time point were compared between both survivors and non-survivors, and patients with either favourable (Cerebral Performance Category (CPC) 1 or 2) or unfavourable neurological outcomes.Results: Twenty-three patients survived for 90 days after CA, and 13 patients achieved favourable neurological outcomes. The PLR values of the survivors and patients with favourable neurological outcomes were consistently greater than those of non-survivors (P < 0.001) and those with unfavourable neurological outcomes (P < 0.001), respectively. The change in PLR over time was not statistically different between the outcome groups. The 0-hour PLR best predicted both 90-day survival (AUC = 0.82, cutoff 3%, sensitivity 0.87, specificity 0.80) and favourable neurological outcomes (AUC = 0.84, cutoff 6%, sensitivity 0.92, specificity 0.74). No patient with a 6-hour PLR less than 3% survived for 90 days after CA.Conclusions: Quantitatively measured PLR was consistently greater in survivors and patients with favourable neurological outcomes during the 72 h after ROSC. Quantitative assessment of PLR at as early as 0 h has a potential role for prognostication in post-CA patients.