ArticleResuscitation plus2025
Association of prehospital pupillary diameter with return of spontaneous circulation and neurological outcome after out-of-hospital cardiac arrest: A multicenter retrospective analysis.
Article in Resuscitation plus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
- Erratum issued
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: In Japan, emergency medical services (EMS) routinely record pupillary size and pupillary light reflex (PLR) during prehospital care for out-of-hospital cardiac arrest (OHCA). While hospital-based studies have established the prognostic value of pupillary findings, the significance of prehospital pupillary diameter remains uncertain. Objective: To examine whether pupillary diameter at EMS contact predicts prehospital return of spontaneous circulation (ROSC) and 30-day neurological outcomes. Methods: This retrospective cohort study analyzed SOS-KANTO 2017, a prospective multicenter OHCA registry. Of 9909 adults, 8494 were eligible after excluding those not in arrest at EMS contact or with missing data. EMS personnel, trained in neurological assessment, documented pupillary diameter using standardized visual charts (0.5-mm increments) but recorded registry values in 1-mm categories (1-8 mm). The primary outcome was prehospital return of spontaneous circulation (ROSC), and the secondary outcome was 30-day favorable neurological status (CPC 1-2). Multivariable logistic regression adjusted for demographics, resuscitation factors, and Utstein variables. Receiver operating characteristic (ROC) analyses, treating failure to achieve ROSC as the positive condition, were performed to assess sensitivity, specificity, and false positive rate (FPR) for futility thresholds. Results: Larger pupillary diameter was independently associated with reduced odds of favorable 30-day outcome (odds ratio [OR] per 1-mm increase, 0.73; 95 % CI 0.61-0.86; Conclusions: Prehospital pupillary diameter is independently associated with both ROSC and 30-day neurological outcome. Although extreme dilation (≥7-8 mm) provides a highly specific marker of futility, low sensitivity precludes its use as a stand-alone criterion. Pupillary assessment may nonetheless contribute, in combination with other prehospital indicators, to a multimodal framework for early decision-making.
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