Cardiac arrest & resuscitation
Validating quantitative pupillometry thresholds for neuroprognostication after out-of-hospital cardiac arrest. A predefined substudy of the Blood Pressure and Oxygenations Targets After Cardiac Arrest (BOX)-trial
Authors' conclusion
Quantitative pupillometry thresholds predict unfavorable neurological outcomes in comatose OHCA survivors and increase the sensitivity of NSE in a multimodal approach at ≥ 72 h.
Study context
- Population
- Comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA)266 (37%) unfavorable outcome
- Participants
- 710 patients
- Comparison
- Automated pupillometry thresholds (qPLR < 4%, NPi ≤ 2) alone and combined with 48-h neuron-specific enolase (NSE) > 60 μg/L for predicting unfavorable neurological outcome
- Outcome
- Prediction of unfavorable neurological outcome (Cerebral Performance Category 3-5 at follow-up) with no false predictions
- Follow-up
- 0, 24, 48 and 72 h
Methodological detailspredefined substudy of the BOX randomised trial, multicentre, consecutive enrolment, Enrolment March 2017 to December 2021
- Predefined substudy of the BOX randomised trial
- Multicentre
- Consecutive enrolment
- Enrolment March 2017 to December 2021
Performance
As reported in the abstract
False-positive rate for unfavorable neurological outcome
| Test or model | Value | False-positive rate (FPR) at all time points (0-72 h) | FPR at 24-72 h |
|---|---|---|---|
| NPi ≤ 2 | 0% | 0% | |
| qPLR < 4% | 0% | 0% |
Value
NPi ≤ 20%
qPLR < 4%0%
False-positive rate (FPR) at all time points (0-72 h)
NPi ≤ 20%
qPLR < 4%— not stated in the abstract
FPR at 24-72 h
NPi ≤ 2— not stated in the abstract
qPLR < 4%0%
Further findings
| Outcome | qPLR < 4% | NPi ≤ 2 | NSE |
|---|---|---|---|
| Multimodal prognostication, sensitivity added to NSE (M ≤ 3 at ≥ 72 h subgroup)qPLR and NPi values are combined with NSE | 55% (interval 47–63%) | 50% (interval 42–58%) | 42% (interval 35–51%) |
- Multimodal prognostication, sensitivity added to NSE (M ≤ 3 at ≥ 72 h subgroup) — Pupillometry thresholds significantly increased sensitivity of NSE, maintaining FPR
- 0% (0-0%)
Original publication
Validating quantitative pupillometry thresholds for neuroprognostication after out-of-hospital cardiac arrest. A predefined substudy of the Blood Pressure and Oxygenations Targets After Cardiac Arrest (BOX)-trial. Intensive Care Med. Published 20 August 2024. doi:10.
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