Association between pupillary examinations and prognosis in patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation: a retrospective multicentre cohort study
Abstract Background In some cases of patients with out-of-hospital cardiac arrest (OHCA) who underwent extracorporeal cardiopulmonary resuscitation (ECPR), negative pupillary light reflex (PLR) and mydriasis upon hospital arrival serve as common early indicator of poor prognosis. However, in certain...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-03-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-024-01265-7 |
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| author | Takuro Hamaguchi Toru Takiguchi Tomohisa Seki Naoki Tominaga Jun Nakata Takeshi Yamamoto Takashi Tagami Akihiko Inoue Toru Hifumi Tetsuya Sakamoto Yasuhiro Kuroda Shoji Yokobori the SAVE-J II study group |
| author_facet | Takuro Hamaguchi Toru Takiguchi Tomohisa Seki Naoki Tominaga Jun Nakata Takeshi Yamamoto Takashi Tagami Akihiko Inoue Toru Hifumi Tetsuya Sakamoto Yasuhiro Kuroda Shoji Yokobori the SAVE-J II study group |
| author_sort | Takuro Hamaguchi |
| collection | DOAJ |
| description | Abstract Background In some cases of patients with out-of-hospital cardiac arrest (OHCA) who underwent extracorporeal cardiopulmonary resuscitation (ECPR), negative pupillary light reflex (PLR) and mydriasis upon hospital arrival serve as common early indicator of poor prognosis. However, in certain patients with poor prognoses inferred by pupil findings upon hospital arrival, pupillary findings improve before and after the establishment of ECPR. The association between these changes in pupillary findings and prognosis remains unclear. This study aimed to clarify the association of pupillary examinations before and after the establishment of ECPR in patients with OHCA showing poor pupillary findings upon hospital arrival with their outcomes. To this end, we analysed retrospective multicentre registry data involving 36 institutions in Japan, including all adult patients with OHCA who underwent ECPR between January 2013 and December 2018. We selected patients with poor prognosis inferred by pupillary examinations, negative pupillary light reflex (PLR) and pupil mydriasis, upon hospital arrival. The primary outcome was favourable neurological outcome, defined as Cerebral Performance Category 1 or 2 at hospital discharge. Multivariable logistic regression analysis was performed to evaluate the association between favourable neurological outcome and pupillary examination after establishing ECPR. Results Out of the 2,157 patients enrolled in the SAVE-J II study, 723 were analysed. Among the patients analysed, 74 (10.2%) demonstrated favourable neurological outcome at hospital discharge. Multivariable analysis revealed that a positive PLR at ICU admission (odds ration [OR] = 11.3, 95% confidence intervals [CI] = 5.17–24.7) was significantly associated with favourable neurological outcome. However, normal pupil diameter at ICU admission (OR = 1.10, 95%CI = 0.52–2.32) was not significantly associated with favourable neurological outcome. Conclusion Among the patients with OHCA who underwent ECPR and showed poor pupillary examination findings upon hospital arrival, 10.2% had favourable neurological outcome at hospital discharge. A positive PLR after the establishment of ECPR was significantly associated with favourable neurological outcome. |
| first_indexed | 2024-04-25T01:04:23Z |
| format | Article |
| id | doaj.art-f02afbfc9dfd4f3f8da7310f4fb74802 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-25T01:04:23Z |
| publishDate | 2024-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-f02afbfc9dfd4f3f8da7310f4fb748022024-03-10T12:22:05ZengSpringerOpenAnnals of Intensive Care2110-58202024-03-0114111010.1186/s13613-024-01265-7Association between pupillary examinations and prognosis in patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation: a retrospective multicentre cohort studyTakuro Hamaguchi0Toru Takiguchi1Tomohisa Seki2Naoki Tominaga3Jun Nakata4Takeshi Yamamoto5Takashi Tagami6Akihiko Inoue7Toru Hifumi8Tetsuya Sakamoto9Yasuhiro Kuroda10Shoji Yokobori11the SAVE-J II study groupDepartment of Emergency and Critical Care Medicine, Nippon Medical SchoolDepartment of Emergency and Critical Care Medicine, Nippon Medical SchoolDepartment of Healthcare Information Management, The University of Tokyo HospitalDepartment of Emergency and Critical Care Medicine, Nippon Medical SchoolDivision of Cardiovascular Intensive Care, Department of Cardiovascular Medicine, Nippon Medical School HospitalDivision of Cardiovascular Intensive Care, Department of Cardiovascular Medicine, Nippon Medical School HospitalDepartment of Emergency and Critical Care Medicine, Nippon Medical SchoolDepartment of Emergency and Critical Care Medicine, Hyogo Emergency Medical CenterDepartment of Emergency and Critical Care Medicine, St. Luke’s International HospitalDepartment of Emergency Medicine, Teikyo University School of MedicineDepartment of Emergency Medicine, Kagawa University School of MedicineDepartment of Emergency and Critical Care Medicine, Nippon Medical SchoolAbstract Background In some cases of patients with out-of-hospital cardiac arrest (OHCA) who underwent extracorporeal cardiopulmonary resuscitation (ECPR), negative pupillary light reflex (PLR) and mydriasis upon hospital arrival serve as common early indicator of poor prognosis. However, in certain patients with poor prognoses inferred by pupil findings upon hospital arrival, pupillary findings improve before and after the establishment of ECPR. The association between these changes in pupillary findings and prognosis remains unclear. This study aimed to clarify the association of pupillary examinations before and after the establishment of ECPR in patients with OHCA showing poor pupillary findings upon hospital arrival with their outcomes. To this end, we analysed retrospective multicentre registry data involving 36 institutions in Japan, including all adult patients with OHCA who underwent ECPR between January 2013 and December 2018. We selected patients with poor prognosis inferred by pupillary examinations, negative pupillary light reflex (PLR) and pupil mydriasis, upon hospital arrival. The primary outcome was favourable neurological outcome, defined as Cerebral Performance Category 1 or 2 at hospital discharge. Multivariable logistic regression analysis was performed to evaluate the association between favourable neurological outcome and pupillary examination after establishing ECPR. Results Out of the 2,157 patients enrolled in the SAVE-J II study, 723 were analysed. Among the patients analysed, 74 (10.2%) demonstrated favourable neurological outcome at hospital discharge. Multivariable analysis revealed that a positive PLR at ICU admission (odds ration [OR] = 11.3, 95% confidence intervals [CI] = 5.17–24.7) was significantly associated with favourable neurological outcome. However, normal pupil diameter at ICU admission (OR = 1.10, 95%CI = 0.52–2.32) was not significantly associated with favourable neurological outcome. Conclusion Among the patients with OHCA who underwent ECPR and showed poor pupillary examination findings upon hospital arrival, 10.2% had favourable neurological outcome at hospital discharge. A positive PLR after the establishment of ECPR was significantly associated with favourable neurological outcome.https://doi.org/10.1186/s13613-024-01265-7Extracorporeal cardiopulmonary resuscitationFavourable neurological outcomeOut-of-hospital cardiac arrestPupillary examination |
| spellingShingle | Takuro Hamaguchi Toru Takiguchi Tomohisa Seki Naoki Tominaga Jun Nakata Takeshi Yamamoto Takashi Tagami Akihiko Inoue Toru Hifumi Tetsuya Sakamoto Yasuhiro Kuroda Shoji Yokobori the SAVE-J II study group Association between pupillary examinations and prognosis in patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation: a retrospective multicentre cohort study Annals of Intensive Care Extracorporeal cardiopulmonary resuscitation Favourable neurological outcome Out-of-hospital cardiac arrest Pupillary examination |
| title | Association between pupillary examinations and prognosis in patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation: a retrospective multicentre cohort study |
| title_full | Association between pupillary examinations and prognosis in patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation: a retrospective multicentre cohort study |
| title_fullStr | Association between pupillary examinations and prognosis in patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation: a retrospective multicentre cohort study |
| title_full_unstemmed | Association between pupillary examinations and prognosis in patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation: a retrospective multicentre cohort study |
| title_short | Association between pupillary examinations and prognosis in patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation: a retrospective multicentre cohort study |
| title_sort | association between pupillary examinations and prognosis in patients with out of hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation a retrospective multicentre cohort study |
| topic | Extracorporeal cardiopulmonary resuscitation Favourable neurological outcome Out-of-hospital cardiac arrest Pupillary examination |
| url | https://doi.org/10.1186/s13613-024-01265-7 |
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