ArticleIntensive care medicine2024
Validating quantitative pupillometry thresholds for neuroprognostication after out-of-hospital cardiac arrest. A predefined substudy of the Blood Pressure and Oxygenations Targets After Cardiac Arrest (BOX)-trial.
Article in Intensive care medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- 2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 6. Post-cardiac arrest care.Clinical and experimental emergency medicine · 2026Guideline
- Comparison of two automated pupillometry indices in patients with acute brain injury: the prospective multicentre LYNX cohort study.Critical care (London, England) · 2026Observational
- Neuroprognostication after cardiac arrest in patients without withdrawal of life-sustaining therapy: a prospective observational multicenter study.Critical care (London, England) · 2026Observational
- Quantitative pupillometry as a sensitive tool for detecting hydrocephalus-related physiologic burden after aSAH: a prospective feasibility study.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026Article
- Association of prehospital pupillary diameter with return of spontaneous circulation and neurological outcome after out-of-hospital cardiac arrest: A multicenter retrospective analysis.Resuscitation plus · 2025Article
- Article
- Shedding Light on Pupillometry Shadows: Understanding Opioid Effects on Pupillary Metrics in ICU Monitoring.Acta anaesthesiologica Scandinavica · 2025Article
- Ultra-early neurological pupil index trajectories and clinical outcomes in acute brain injury.Frontiers in neurologyArticle
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Authors and funding
10 authors.
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Abstract
purposeOut-of-hospital cardiac arrest (OHCA) survivors face significant risks of complications and death from hypoxic-ischemic brain injury leading to withdrawal of life-sustaining treatment (WLST). Accurate multimodal neuroprognostication, including automated pupillometry, is essential to avoid inappropriate WLST. However, inconsistent study results hinder standardized threshold recommendations. We aimed to validate proposed pupillometry thresholds with no false predictions of unfavorable outcomes in comatose OHCA survivors.
methodsIn the multi-center BOX-trial, quantitative measurements of automated pupillometry (quantitatively assessed pupillary light reflex [qPLR] and Neurological Pupil index [NPi]) were obtained at admission (0 h) and after 24, 48, and 72 h in comatose patients resuscitated from OHCA. We aimed to validate qPLR < 4% and NPi ≤ 2, predicting unfavorable neurological conditions defined as Cerebral Performance Category 3-5 at follow-up. Combined with 48-h neuron-specific enolase (NSE) > 60 μg/L, pupillometry was evaluated for multimodal neuroprognostication in comatose patients with Glasgow Motor Score (M) ≤ 3 at ≥ 72 h.
resultsFrom March 2017 to December 2021, we consecutively enrolled 710 OHCA survivors (mean age: 63 ± 14 years; 82% males), and 266 (37%) patients had unfavorable neurological outcomes. An NPi ≤ 2 predicted outcome with 0% false-positive rate (FPR) at all time points (0-72 h), and qPLR < 4% at 24-72 h. In patients with M ≤ 3 at ≥ 72 h, pupillometry thresholds significantly increased the sensitivity of NSE, from 42% (35-51%) to 55% (47-63%) for qPLR and 50% (42-58%) for NPi, maintaining 0% (0-0%) FPR.
conclusionQuantitative pupillometry thresholds predict unfavorable neurological outcomes in comatose OHCA survivors and increase the sensitivity of NSE in a multimodal approach at ≥ 72 h.
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