Early neurological pupil index to predict outcome after cardiac arrest

Te prediction of unfavorable neurological outcome (UO) in comatose patients resuscitated from cardiac arrest (CA) is complex. A bilateral absence of the pupillary light refex ≥72 h after the arrest is considered among the most accurate predictors of UO in these patients. We performed a post hoc analysis of an international prospective multicenter cohort study enrolling adult (>18 years) comatose patients after CA admitted to ten European intensive care units (ICUs) from January 2015 to March 2017. The analysis assessed the prognostic role of Neurological Pupil Index (NPi) on day 1–3 with UO in this patients’ population. Among 456 patients enrolled in the study, 329 had NPi measured on hospital or ICU admission. NPi on admission was signifcantly lower in patients with UO (3.7 [2.3–4.2] vs. 4.1 [3.7–4.4]; p<0.01). the AUROC to predict UO was 0.65 (95% confdence interval, CI 0.59–0.71). Our study showed that a NPi ≤2 has a good specifcity for predicting unfavorable outcome in unconscious patients after resuscitation from CA, as early as hospital or ICU admission. NPi can be useful as a rapid bedside tool for identifying patients with severe brain injury and triaging them for a rapid transfer to cardiac arrest centers, or for inclusion in studies assessing neuroprotective strategies