Abstract
Introduction
Loss of pupillary light reactivity (PLR) three days after a cardiorespiratory arrest
is a prognostic factor. Its predictive value upon hospital admission remains unclear.
Our objective was to determine the prognostic value of the absence of PLR upon hospital
admission in patients with out-of-hospital cardiac arrest.
Methods
We prospectively included all out-of-hospital cardiac arrests occurring between July
2011 and July 2017 treated by a mobile medical team (MMT) based on data from a French
cardiac arrest registry database. PLR was evaluated upon hospital admission and the
outcome on day 30. The prognosis was classified as good for Cerebral Performance Category
(CPC) 1 or 2, and poor for CPC 3–5 or in case of death.
Results
Data from 10151 patients was analysed. The sensitivity and specificity of the absence
of PLR for a poor outcome were 72.2% (71.2–73.2) and 68.8% (66.7–70.1), respectively.
We identified several variables modifying the sensitivity values and the false positive
fraction of a factor, ranging from 0.49 (0.35–0.69) for the Glasgow Coma Scale to
2.17 (1.09–2.48) for pupillary asymmetry. Among those living with CPC 1 or 2 on day
30 (n = 1990; 19.6%), 621 (31.2% (29.2–33.3)) had no PLR upon hospital admission.
In the multivariate analysis, loss of PLR was associated with a poor outcome (OR = 3.1
(2.7–3.5)).
Conclusions
Loss of pupillary light reactivity upon hospital admission is predictive of a poor
outcome after out-of-hospital cardiac arrest. However, it does not have sufficient
accuracy to determine prognosis and decision making.
Keywords
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Article info
Publication history
Published online: March 12, 2018
Accepted:
March 10,
2018
Received in revised form:
March 2,
2018
Received:
February 3,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
