Quantitative pupillometry and neuron-specific enolase independently predict return of spontaneous circulation following cardiogenic out-of-hospital cardiac arrest

a prospective pilot study

Shoji Yokobori, Kevin K.K. Wang, Zhihui Yang, Tian Zhu, Joseph A. Tyndall, Stefania Mondello, Yasushi Shibata, Naoki Tominaga, Takahiro Kanaya, Toru Takiguchi, Yutaka Igarashi, Jun Hagiwara, Ryuta Nakae, Hidetaka Onda, Tomohiko Masuno, Akira Fuse, Hiroyuki Yokota

Research output: Contribution to journalArticle

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Abstract

This study aimed to identify neurological and pathophysiological factors that predicted return of spontaneous circulation (ROSC) among patients with out-of-hospital cardiac arrest (OHCA). This prospective 1-year observational study evaluated patients with cardiogenic OHCA who were admitted to a tertiary medical center, Nippon Medical School Hospital. Physiological and neurological examinations were performed at admission for quantitative infrared pupillometry (measured with NPi-200, NeurOptics, CA, USA), arterial blood gas, and blood chemistry. Simultaneous blood samples were also collected to determine levels of neuron-specific enolase (NSE), S-100b, phosphorylated neurofilament heavy subunit, and interleukin-6. In-hospital standard advanced cardiac life support was performed for 30 minutes.The ROSC (n = 26) and non-ROSC (n = 26) groups were compared, which a revealed significantly higher pupillary light reflex ratio, which was defined as the percent change between maximum pupil diameter before light stimuli and minimum pupil diameter after light stimuli, in the ROSC group (median: 1.3% [interquartile range (IQR): 0.0–2.0%] vs. non-ROSC: (median: 0%), (Cut-off: 0.63%). Furthermore, NSE provided the great sensitivity and specificity for predicting ROSC, with an area under the receiver operating characteristic curve of 0.86, which was created by plotting sensitivity and 1-specificity. Multivariable logistic regression analyses revealed that the independent predictors of ROSC were maximum pupillary diameter (odds ratio: 0.25, 95% confidence interval: 0.07–0.94, P = 0.04) and NSE at admission (odds ratio: 0.96, 95% confidence interval: 0.93–0.99, P = 0.04). Pupillary diameter was also significantly correlated with NSE concentrations (r = 0.31, P = 0.027). Conclusively, the strongest predictors of ROSC among patients with OHCA were accurate pupillary diameter and a neuronal biomarker, NSE. Quantitative pupillometry may help guide the decision to terminate resuscitation in emergency departments using a neuropathological rationale. Further large-scale studies are needed.

Original languageEnglish
Article number15964
JournalScientific Reports
Volume8
Issue number1
DOIs
Publication statusPublished - Dec 1 2018

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Out-of-Hospital Cardiac Arrest
Phosphopyruvate Hydratase
Prospective Studies
Pupil
Light
Advanced Cardiac Life Support
Odds Ratio
Pupillary Reflex
Confidence Intervals
Sensitivity and Specificity
Intermediate Filaments
Neurologic Examination
Medical Schools
Resuscitation
ROC Curve
Observational Studies
Hospital Emergency Service
Interleukin-6
Biomarkers
Gases

ASJC Scopus subject areas

  • General

Cite this

Quantitative pupillometry and neuron-specific enolase independently predict return of spontaneous circulation following cardiogenic out-of-hospital cardiac arrest : a prospective pilot study. / Yokobori, Shoji; Wang, Kevin K.K.; Yang, Zhihui; Zhu, Tian; Tyndall, Joseph A.; Mondello, Stefania; Shibata, Yasushi; Tominaga, Naoki; Kanaya, Takahiro; Takiguchi, Toru; Igarashi, Yutaka; Hagiwara, Jun; Nakae, Ryuta; Onda, Hidetaka; Masuno, Tomohiko; Fuse, Akira; Yokota, Hiroyuki.

In: Scientific Reports, Vol. 8, No. 1, 15964, 01.12.2018.

Research output: Contribution to journalArticle

Yokobori, S, Wang, KKK, Yang, Z, Zhu, T, Tyndall, JA, Mondello, S, Shibata, Y, Tominaga, N, Kanaya, T, Takiguchi, T, Igarashi, Y, Hagiwara, J, Nakae, R, Onda, H, Masuno, T, Fuse, A & Yokota, H 2018, 'Quantitative pupillometry and neuron-specific enolase independently predict return of spontaneous circulation following cardiogenic out-of-hospital cardiac arrest: a prospective pilot study', Scientific Reports, vol. 8, no. 1, 15964. https://doi.org/10.1038/s41598-018-34367-x
Yokobori, Shoji ; Wang, Kevin K.K. ; Yang, Zhihui ; Zhu, Tian ; Tyndall, Joseph A. ; Mondello, Stefania ; Shibata, Yasushi ; Tominaga, Naoki ; Kanaya, Takahiro ; Takiguchi, Toru ; Igarashi, Yutaka ; Hagiwara, Jun ; Nakae, Ryuta ; Onda, Hidetaka ; Masuno, Tomohiko ; Fuse, Akira ; Yokota, Hiroyuki. / Quantitative pupillometry and neuron-specific enolase independently predict return of spontaneous circulation following cardiogenic out-of-hospital cardiac arrest : a prospective pilot study. In: Scientific Reports. 2018 ; Vol. 8, No. 1.
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AU - Yang, Zhihui

AU - Zhu, Tian

AU - Tyndall, Joseph A.

AU - Mondello, Stefania

AU - Shibata, Yasushi

AU - Tominaga, Naoki

AU - Kanaya, Takahiro

AU - Takiguchi, Toru

AU - Igarashi, Yutaka

AU - Hagiwara, Jun

AU - Nakae, Ryuta

AU - Onda, Hidetaka

AU - Masuno, Tomohiko

AU - Fuse, Akira

AU - Yokota, Hiroyuki

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N2 - This study aimed to identify neurological and pathophysiological factors that predicted return of spontaneous circulation (ROSC) among patients with out-of-hospital cardiac arrest (OHCA). This prospective 1-year observational study evaluated patients with cardiogenic OHCA who were admitted to a tertiary medical center, Nippon Medical School Hospital. Physiological and neurological examinations were performed at admission for quantitative infrared pupillometry (measured with NPi-200, NeurOptics, CA, USA), arterial blood gas, and blood chemistry. Simultaneous blood samples were also collected to determine levels of neuron-specific enolase (NSE), S-100b, phosphorylated neurofilament heavy subunit, and interleukin-6. In-hospital standard advanced cardiac life support was performed for 30 minutes.The ROSC (n = 26) and non-ROSC (n = 26) groups were compared, which a revealed significantly higher pupillary light reflex ratio, which was defined as the percent change between maximum pupil diameter before light stimuli and minimum pupil diameter after light stimuli, in the ROSC group (median: 1.3% [interquartile range (IQR): 0.0–2.0%] vs. non-ROSC: (median: 0%), (Cut-off: 0.63%). Furthermore, NSE provided the great sensitivity and specificity for predicting ROSC, with an area under the receiver operating characteristic curve of 0.86, which was created by plotting sensitivity and 1-specificity. Multivariable logistic regression analyses revealed that the independent predictors of ROSC were maximum pupillary diameter (odds ratio: 0.25, 95% confidence interval: 0.07–0.94, P = 0.04) and NSE at admission (odds ratio: 0.96, 95% confidence interval: 0.93–0.99, P = 0.04). Pupillary diameter was also significantly correlated with NSE concentrations (r = 0.31, P = 0.027). Conclusively, the strongest predictors of ROSC among patients with OHCA were accurate pupillary diameter and a neuronal biomarker, NSE. Quantitative pupillometry may help guide the decision to terminate resuscitation in emergency departments using a neuropathological rationale. Further large-scale studies are needed.

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