Abstract
Objective: Physiologic monitoring & neuroprognostication during resuscitation are relatively crude. Real time assessment of neurophysiology could be useful to guide resuscitative efforts. Objective assessment of the pupillary light reflex [PLR] is feasible during IHCA with a portable pupillometer, & PLR is associated with survival & neurologic outcome. We are conducting a prospective, observational study to assess the translational potential of pupillometry in the prehospital setting for OHCA. Hypotheses: Prehospital pupillometry is feasible & qualitative assessment of PLR is associated with patient outcomes. Methods: Portable pupillometers (NeurOptics, Inc) were deployed for subjects with EMS treated OHCA. Serial recordings were obtained during routine pulse checks until ROSC, termination, or hospital arrival. We qualified PLR as normal/abnormal/absent with Neurologic Pupillary Index (NPiTM), a continuous scale that combines facets of PLR (e.g. % change, velocity, latency). We reviewed prehospital & hospital records to identify patient characteristics & outcomes, tabulated data as means/medians/proportions, & estimated test performance characteristics. Results: From 2/14 - 6/14, a pupillometer was deployed to 38/58 (66%) patients with EMS treated OHCA (63 ± 16 years, 66% male, 33% witnessed, 54% bystander CPR, 11% shockable rhythm). Of 38 subjects, 21 (56%) were transported (19 ROSC & 2 CPR). At the time of submission, follow-up data were available on 27 (71%) patients (6 survived to admission, 4 had therapeutic hypothermia, 3 had cardiac catheterization, 1 survived to discharge with excellent neurologic recovery). In total, 385 readings were attempted (median 8.5 attempts/patient; IQR 6-12). Median 47% (IQR 25%, 67%) readings had usable data. Most (92%) patients had ≥1 usable reading and 9/38 (24%) had any PLR during resuscitation. Conclusion: Prehospital pupillometry is feasible & may yield prognostic information during resuscitation.
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