PDF(Pubmed)
Abstract：
UNASSIGNED: In neurologic prognostication of comatose survivors from cardiac arrest, two independent predictors of poor outcome are the loss of the Pupillary light reflex (PLR) and the loss of the N20 response from Somatosensory Evoked potentials (SSEP). The PLR can be quantitatively assessed by pupillometry. Both tests depend on the midbrain, in which a dysfunction reflects a severe hypoxic injury. We reasoned that a certain level of defective PLR would be predictive of a bilaterally absent SSEP N20 response.
UNASSIGNED: Neurological Pupil index (NPi) from the pupillometry and the SSEP N20 response were registered >48 h after cardiac arrest in comatose survivors. Clinical data were retrospectively analyzed. A receiver operating characteristic curve was used to evaluate the capacity of NPi to predict bilaterally absent SSEP N20 response. An NPi threshold value resulting in <5% false positive rate (FPR) for bilaterally absent N20 response was identified.
UNASSIGNED: From February 2020 to August 2022, we included 54 patients out of which 49 had conclusive pupillometry and SSEP examinations. The NPi threshold value with FPR < 5% was 3.4, yielding 36% sensitivity (95% CI 18-55) and significantly discriminated between respective groups with preserved and bilaterally absent N20 response to SSEP (p-value <0.01).
UNASSIGNED: In this limited cohort, NPi < 3.4 in patients remaining comatose >48 hours after cardiac arrest predicted bilateral loss of the SSEP N20 response with a FPR < 5%. If validated in a larger cohort, an NPi threshold may be clinically applied in settings where SSEP is unavailable.
UNASSIGNED: Neurological Pupil index (NPi) from the pupillometry and the SSEP N20 response were registered >48 h after cardiac arrest in comatose survivors. Clinical data were retrospectively analyzed. A receiver operating characteristic curve was used to evaluate the capacity of NPi to predict bilaterally absent SSEP N20 response. An NPi threshold value resulting in <5% false positive rate (FPR) for bilaterally absent N20 response was identified.
UNASSIGNED: From February 2020 to August 2022, we included 54 patients out of which 49 had conclusive pupillometry and SSEP examinations. The NPi threshold value with FPR < 5% was 3.4, yielding 36% sensitivity (95% CI 18-55) and significantly discriminated between respective groups with preserved and bilaterally absent N20 response to SSEP (p-value <0.01).
UNASSIGNED: In this limited cohort, NPi < 3.4 in patients remaining comatose >48 hours after cardiac arrest predicted bilateral loss of the SSEP N20 response with a FPR < 5%. If validated in a larger cohort, an NPi threshold may be clinically applied in settings where SSEP is unavailable.
摘要：
■在心脏骤停昏迷幸存者的神经系统预测中，不良结局的两个独立预测因素是瞳孔光反射(PLR)丧失和体感诱发电位(SSEP)N20反应丧失.PLR可以通过瞳孔测量法定量评估。两种测试都取决于中脑，其中功能障碍反映了严重的缺氧损伤。我们推断，一定水平的缺陷PLR可以预测双侧缺乏SSEPN20反应。
■在昏迷幸存者心脏骤停后48小时，根据瞳孔测量和SSEPN20反应记录了神经学瞳孔指数（NPi）。对其临床资料进行回顾性分析。接收器工作特性曲线用于评估NPi预测双侧缺乏SSEPN20响应的能力。鉴定了导致双侧不存在N20反应的<5%假阳性率(FPR)的NPi阈值。
■从2020年2月到2022年8月，我们纳入了54例患者，其中49例进行了结论性的瞳孔测量和SSEP检查。FPR<5％的NPi阈值为3.4，灵敏度为36％（95％CI18-55），并且在保留和双侧无N20对SSEP反应的各组之间显着区分（p值<0.01）。
■在这个有限的队列中，在心脏骤停后仍保持昏迷状态>48小时的患者中，NPi<3.4预测SSEPN20反应的双侧丧失，FPR<5％。如果在更大的队列中验证，NPi阈值可在SSEP不可用的环境中临床应用.
■在昏迷幸存者心脏骤停后48小时，根据瞳孔测量和SSEPN20反应记录了神经学瞳孔指数（NPi）。对其临床资料进行回顾性分析。接收器工作特性曲线用于评估NPi预测双侧缺乏SSEPN20响应的能力。鉴定了导致双侧不存在N20反应的<5%假阳性率(FPR)的NPi阈值。
■从2020年2月到2022年8月，我们纳入了54例患者，其中49例进行了结论性的瞳孔测量和SSEP检查。FPR<5％的NPi阈值为3.4，灵敏度为36％（95％CI18-55），并且在保留和双侧无N20对SSEP反应的各组之间显着区分（p值<0.01）。
■在这个有限的队列中，在心脏骤停后仍保持昏迷状态>48小时的患者中，NPi<3.4预测SSEPN20反应的双侧丧失，FPR<5％。如果在更大的队列中验证，NPi阈值可在SSEP不可用的环境中临床应用.
