Cardiac arrest & resuscitation
The impact of pupil diameter on assessing illness severity and outcome after out-of-hospital cardiac arrest in patients with unreactive pupils
Authors' conclusion
Absent PLR immediately following ROSC is associated with poor outcomes but does not preclude good outcome. Pupil size and reactivity immediately post-ROSC may help to differentiate brain injury phenotypes.
Study context
- Population
- Out-of-hospital cardiac arrest (OHCA) patients with early post-ROSC pupil size and reactivity data, 2018–2024
- Participants
- 382 patients
- Exposure
- Absent pupillary light reflex (PLR) with dilated pupils vs absent PLR without dilated pupils
- Absent PLRn = 194
- Absent PLR and dilated pupilsn = 132
- Outcome
- Association of post-ROSC pupil size and reactivity with illness severity and clinical outcomes
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
False positive rate of absent PLR for mortality
10.9 %
False positive rate of absent PLR for poor neurologic outcome
5.9 %
Dilated pupils among absent PLR
68 %
Observational data: associations, not effects.
Further findings
| Outcome | AUC (CI) | P value |
|---|---|---|
| Brain death, among absent PLR (dilated vs not dilated pupils)34.8 % vs. 9.7 % | P < 0.001 | |
| Prediction of brain death among absent PLR, with vs without dilated pupilsvs 0.683 (0.628-0.738) | 0.733 (0.672–0.793) | P = 0.026 |
Original publication
The impact of pupil diameter on assessing illness severity and outcome after out-of-hospital cardiac arrest in patients with unreactive pupils. Resuscitation. Published 27 June 2025. doi:10.
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