Abstract | BACKGROUND: METHODS: An observational cohort of sedated, mechanically ventilated VA-ECMO patients was analyzed during the early phase after ECMO insertion (first 72 h). Using the NPi-200 automated infrared pupillometer, pupillary light reactivity was assessed repeatedly (every 12 h) by calculating the Neurological Pupil index (NPi). Trends of NPi over time were correlated to 90-day mortality, and the prognostic performance of the NPi, alone and in combination with the 12-h PREDICT VA-ECMO score, was evaluated. RESULTS: One hundred consecutive patients were studied (51 with refractory cardiogenic shock and 49 with refractory cardiac arrest; 12-h PREDICT VA-ECMO, 40%; observed 90-day survival, 43%). Nonsurvivors (n = 57) had significantly lower NPi than did survivors at all time points (all P < .01). Abnormal NPi (< 3, at any time from 24 to 72 h) was 100% specific for 90-day mortality, with 0% false positives. Adding the 12-h PREDICT VA-ECMO score to the NPi provided the best prognostic performance (specificity, 100% [95% CI, 92%-100%]; sensitivity, 60% [95% CI, 46%-72%]; area under the receiver operating characteristic curve, 0.82). CONCLUSIONS: Quantitative NPi alone had excellent ability to predict a poor outcome from day 1 after VA-ECMO insertion, with no false positives. Combining NPi and 12-h PREDICT-VA ECMO score increased the sensitivity of outcome prediction, while maintaining 100% specificity.
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Authors | John-Paul Miroz, Nawfel Ben-Hamouda, Adriano Bernini, Federico Romagnosi, Filippo Bongiovanni, Aurélien Roumy, Matthias Kirsch, Lucas Liaudet, Philippe Eckert, Mauro Oddo |
Journal | Chest
(Chest)
Vol. 157
Issue 5
Pg. 1167-1174
(05 2020)
ISSN: 1931-3543 [Electronic] United States |
PMID | 31870911
(Publication Type: Journal Article, Observational Study)
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Copyright | Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. |
Topics |
- Aged
- Coma
- Extracorporeal Membrane Oxygenation
- Female
- Heart Arrest
(mortality, therapy)
- Humans
- Middle Aged
- Neurologic Examination
(methods)
- Prognosis
- Reflex, Pupillary
- Sensitivity and Specificity
- Shock, Cardiogenic
(mortality, therapy)
- Survival Rate
- Switzerland
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