Neurological Pupil Index and its association with other prognostic tools after cardiac arrest: A post hoc analysis,Resuscitation

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Neurological Pupil Index and its association with other prognostic tools after cardiac arrest: A post hoc analysis
Resuscitation ( IF 6.5 ) Pub Date : 2022-07-30 , DOI: 10.1016/j.resuscitation.2022.07.030
Lorenzo Peluso ₁ , Mauro Oddo ₂ , Andrea Minini ₃ , Giuseppe Citerio ₄ , Janneke Horn ₅ , Eugenio Di Bernardini ₃ , Malin Rundgren ₆ , Alain Cariou ₇ , Jean-Francois Payen ₈ , Christian Storm ₉ , Pascal Stammet ₁₀ , Claudio Sandroni ₁₁ , Fabio Silvio Taccone ₃

Affiliation

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.
Medical Directorate for Research, Education, Innovation, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
School of Medicine and Surgery, University Milano Bicocca, Neuro-intensive Care Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy.
Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam Neurosciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine, Skåne University Hospital, Lund University, Lund, Sweden.
Intensive Care Unit, Hopital Cochin, Paris, France; Paris Descartes University, Paris, France.
Department of Anesthesia and Critical Care, Grenoble Alpes University Hospital, Grenoble, France.
Department of Internal Medicine, Nephrology and Intensive Care, Charité-University, Berlin, Germany.
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.
Department of Intensive Care Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy.

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.

中文翻译：

心脏骤停后神经瞳孔指数及其与其他预后工具的关联：事后分析

介绍

我们评估了神经瞳孔指数 (NPi) 与心脏骤停 (CA) 后其他结果预测因子的一致性。

方法

一项前瞻性、国际性、多中心研究（包括成年 CA 患者）的事后分析。不利结果的预测因素（UO，3 个月时的脑性能类别 3-5）包括：a) 最差 NPi ≤2；b) 存在不连续脑电图 (EEG) 背景；c) 体感诱发电位 (N20 _ABS ) 双侧 N20 波缺失；d) 峰值神经元特异性烯醇化酶 (NSE) 血液水平 >60 mcg/L；e) 肌阵挛，所有这些都在接受完整多模式评估 (MMM) 的患者子集中进行了测试。

结果

共有 269/456 (59%) 名患者患有 UO，186 名 (41%) 患者接受了 MMM。在所有患者中评估了肌阵挛的存在，358 例 (78%) 的脑电图，186 例 (41%) 的 N20 和 228 例 (50%) 的 NSE 测量。_{脑电图不连续、N20 ABS}或高 NSE 的患者最差 NPi≤2 的比例较高。NPi 预测不连续 EEG、N20 _ABS、高 NSE 和肌阵挛存在的准确性是中等的。

NSE 与 NPi ≤2 的一致性高，不连续 EEG 和 N20 _ABS的一致性适中。此外，预后不良的一致预测因子数量越多，观察到的 NPi 越低。