Quantitative pupillometry for neuroprognostication in comatose post-cardiac arrest patients: A protocol for a predefined sub-study of the Blood pressure and Oxygenations Targets after Out-of-Hospital Cardiac Arrest (BOX)-trial
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Quantitative pupillometry for neuroprognostication in comatose post-cardiac arrest patients : A protocol for a predefined sub-study of the Blood pressure and Oxygenations Targets after Out-of-Hospital Cardiac Arrest (BOX)-trial. / Nyholm, Benjamin; Grand, Johannes; Obling, Laust Emil Roelsgaard; Hassager, Christian; Møller, Jacob Eifer; Schmidt, Henrik; Othman, Marwan H.; Kondziella, Daniel; Kjaergaard, Jesper.
In: Resuscitation Plus, Vol. 16, 100475, 2023.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Quantitative pupillometry for neuroprognostication in comatose post-cardiac arrest patients
T2 - A protocol for a predefined sub-study of the Blood pressure and Oxygenations Targets after Out-of-Hospital Cardiac Arrest (BOX)-trial
AU - Nyholm, Benjamin
AU - Grand, Johannes
AU - Obling, Laust Emil Roelsgaard
AU - Hassager, Christian
AU - Møller, Jacob Eifer
AU - Schmidt, Henrik
AU - Othman, Marwan H.
AU - Kondziella, Daniel
AU - Kjaergaard, Jesper
N1 - Publisher Copyright: © 2023 The Author(s)
PY - 2023
Y1 - 2023
N2 - Background: Resuscitation guidelines propose a multimodal prognostication strategy algorithm at ≥72 hours after the return of spontaneous circulation to evaluate neurological outcome for unconscious cardiac arrest survivors. Even though guidelines suggest quantitative pupillometry for assessing pupillary light reflex, threshold values are not yet validated. This study aims to validate pre-specified thresholds of quantitative pupillometry by quantitatively assessing the percentage reduction of pupillary size (qPLR) <4% and Neurological Pupil index (NPi) ≤2 and in predicting unfavorable neurological outcome. Both as an isolated predictor and combined with guideline-suggested neuron-specific enolase (NSE) threshold >60 μg L−1 in the current prognostication strategy algorithm. Methods: We conduct this pre-planned diagnostic sub-study in the randomized, controlled, multicenter clinical trial “Blood Pressure and Oxygenation Targets after Out-of-Hospital Cardiac Arrest-trial”. Blinded to treating physicians and outcome assessors, measurements of qPLR and NPi are obtained from cardiac arrest survivors at time points (±6 hours) of admission, after 24, 48, and 72 hours, or until the time of awakening or death. Discussion: This study will be the largest prospective study investigating the predictive performance of automated quantitative pupillometry in unconscious patients resuscitated from cardiac arrest. We will test specific threshold values of NPi ≤2 and qPLR <4% to predict unfavorable outcome following cardiac arrest. The validation of pupillometry alone and combined with NSE with the criteria of the current prognostication strategy algorithm will hopefully increase the level of evidence and support clinical neuroprognostication with automated quantitative pupillometry in unconscious post-cardiac arrest patients. Trial registration: Registered March 30, 2017, at ClinicalTrials.gov (Identifier: NCT03141099).
AB - Background: Resuscitation guidelines propose a multimodal prognostication strategy algorithm at ≥72 hours after the return of spontaneous circulation to evaluate neurological outcome for unconscious cardiac arrest survivors. Even though guidelines suggest quantitative pupillometry for assessing pupillary light reflex, threshold values are not yet validated. This study aims to validate pre-specified thresholds of quantitative pupillometry by quantitatively assessing the percentage reduction of pupillary size (qPLR) <4% and Neurological Pupil index (NPi) ≤2 and in predicting unfavorable neurological outcome. Both as an isolated predictor and combined with guideline-suggested neuron-specific enolase (NSE) threshold >60 μg L−1 in the current prognostication strategy algorithm. Methods: We conduct this pre-planned diagnostic sub-study in the randomized, controlled, multicenter clinical trial “Blood Pressure and Oxygenation Targets after Out-of-Hospital Cardiac Arrest-trial”. Blinded to treating physicians and outcome assessors, measurements of qPLR and NPi are obtained from cardiac arrest survivors at time points (±6 hours) of admission, after 24, 48, and 72 hours, or until the time of awakening or death. Discussion: This study will be the largest prospective study investigating the predictive performance of automated quantitative pupillometry in unconscious patients resuscitated from cardiac arrest. We will test specific threshold values of NPi ≤2 and qPLR <4% to predict unfavorable outcome following cardiac arrest. The validation of pupillometry alone and combined with NSE with the criteria of the current prognostication strategy algorithm will hopefully increase the level of evidence and support clinical neuroprognostication with automated quantitative pupillometry in unconscious post-cardiac arrest patients. Trial registration: Registered March 30, 2017, at ClinicalTrials.gov (Identifier: NCT03141099).
KW - Cardiac arrest
KW - Guidelines
KW - Post resuscitation care
KW - Prognostication
KW - Quantitative Pupillometry
U2 - 10.1016/j.resplu.2023.100475
DO - 10.1016/j.resplu.2023.100475
M3 - Journal article
C2 - 37779885
AN - SCOPUS:85172198230
VL - 16
JO - Resuscitation Plus
JF - Resuscitation Plus
SN - 2666-5204
M1 - 100475
ER -
ID: 379034407