BACKGROUND Veno-arterial extra-corporeal membrane oxygenation therapy (VA-ECMO) following refractory cardiogenic shock (r-CS) or cardiac arrest (r-CA) has significant morbidity and mortality. Early outcome prediction is crucial in this setting, but data on neuro-prognostication are limited. We examined the prognostic value of clinical neurological examination, using an automated device for the quantitative measurement of pupillary light reactivity. METHODS An observational cohort of sedated mechanically ventilated VA-ECMO patients was analyzed at the early phase following ECMO insertion (first 72 hours). Using the NPi®-200 automated infrared pupillometer, pupillary light reactivity was assessed repeatedly (every 12 hours) by calculating the Neurological Pupil index (NPi). Trends of NPi over time were correlated to 90-day mortality, and the prognostic performance of the NPi, alone and in combination with the 12-h PREDICT VA-ECMO score, was evaluated. RESULTS A total 100 consecutives patients were studied (51 r-CS/49 r-CA; 12-h PREDICT VA-ECMO 40%; observed 90-day survival 43%). Non-survivors (n=57) had significantly lower NPi than survivors at all time-points (all p<0.01). Abnormal NPi (<3, at any time from 24 to 72 hours) was 100% specific for 90-day mortality, with 0% false positives. Adding 12-h PREDICT VA-ECMO score to the NPi provided the best prognostic performance (specificity 100% [95% confidence interval 91-100%], sensitivity 60% [46-72%], area under the ROC curve 0.82). CONCLUSIONS Quantitative NPi alone had excellent ability to predict a poor outcome from day 1 after VA-ECMO insertion, with no false positives. Combining NPi and 12-h PREDICT-VA ECMO score increased sensitivity of outcome prediction, while maintaining 100% specificity.

中文翻译：

---

静脉-动脉体外膜氧合后早期预后的神经学瞳孔指数

背景 难治性心源性休克 (r-CS) 或心脏骤停 (r-CA) 后的静脉-动脉体外膜肺氧合治疗 (VA-ECMO) 具有显着的发病率和死亡率。在这种情况下，早期结果预测至关重要，但有关神经预后的数据有限。我们检查了临床神经学检查的预后价值，使用自动装置定量测量瞳孔光反应性。方法 在 ECMO 插入后的早期阶段（第一个 72 小时）分析了一个观察性队列的镇静机械通气 VA-ECMO 患者。使用 NPi®-200 自动红外瞳孔计，通过计算神经瞳孔指数 (NPi) 重复评估瞳孔光反应性（每 12 小时）。NPi 随时间变化的趋势与 90 天死亡率相关，并且评估了 NPi 单独和结合 12 小时 PREDICT VA-ECMO 评分的预后性能。结果 研究了总共 100 名连续患者（51 r-CS/49 r-CA；12 小时 PREDICT VA-ECMO 40%；观察到的 90 天存活率为 43%）。在所有时间点，非幸存者（n=57）的 NPi 均显着低于幸存者（所有 p<0.01）。异常 NPi（<3，在 24 至 72 小时内的任何时间）对 90 天死亡率的特异性为 100%，假阳性率为 0%。将 12 小时 PREDICT VA-ECMO 评分添加到 NPi 提供了最佳的预后性能（特异性 100% [95% 置信区间 91-100%]，敏感性 60% [46-72%]，ROC 曲线下面积 0.82）。结论 单独定量 NPi 具有出色的能力，可以预测 VA-ECMO 插入后第 1 天的不良结果，没有假阳性。