[en] [en] 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 (N20ABS); 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, N20ABS or high NSE had a higher proportion of worst NPi ≤ 2. The accuracy for NPi to predict a discontinuous EEG, N20ABS, high NSE and the presence of myoclonus was moderate. Concordance with NPi ≤ 2 was high for NSE, and moderate for discontinuous EEG and N20ABS. 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.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Peluso, Lorenzo; 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. Electronic address: lorenzopeluso80@gmail.com
Oddo, Mauro; Medical Directorate for Research, Education, Innovation, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
Minini, Andrea; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
Citerio, Giuseppe; School of Medicine and Surgery, University Milano Bicocca, Neuro-intensive Care Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy
Horn, Janneke; Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands, Amsterdam Neurosciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
Di Bernardini, Eugenio; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
Rundgren, Malin; Department of Clinical Sciences, Anesthesiology and Intensive Care Medicine, Skåne University Hospital, Lund University, Lund, Sweden
Cariou, Alain; Intensive Care Unit, Hopital Cochin, Paris, France, Paris Descartes University, Paris, France
Payen, Jean-Francois; Department of Anesthesia and Critical Care, Grenoble Alpes University Hospital, Grenoble, France
Storm, Christian; Department of Internal Medicine, Nephrology and Intensive Care, Charité-University, Berlin, Germany
STAMMET, Pascal ; University of Luxembourg > Faculty of Science, Technology and Medicine (FSTM) > Department of Life Sciences and Medicine (DLSM) > Medical Education
Sandroni, Claudio; Department of Intensive Care Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
Taccone, Fabio Silvio; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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