Efficacy of Quantitative Pupillary Light Reflex for Predicting Neurological Outcomes in Patients Treated with Targeted Temperature Management after Cardiac Arrest: A Systematic Review and Meta-Analysisopen access
- Authors
- Kim, Jae-Guk; Shin, Hyungoo; Lim, Tae-Ho; Kim, Wonhee; Cho, Youngsuk; Jang, Bo-Hyoung; Choi, Kyu-Sun; Na, Min-Kyun; Ahn, Chiwon; Lee, Juncheol
- Issue Date
- Jun-2022
- Publisher
- MDPI
- Keywords
- pupillometry; targeted temperature management; heart arrest; patient outcome assessment; me-ta-analysis
- Citation
- MEDICINA-LITHUANIA, v.58, no.6
- Journal Title
- MEDICINA-LITHUANIA
- Volume
- 58
- Number
- 6
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/61292
- DOI
- 10.3390/medicina58060804
- ISSN
- 1010-660X
1648-9144
- Abstract
- Background and objectives: This study aims to evaluate the usefulness of the quantitative pupillary light reflex as a prognostic tool for neurological outcomes in post-cardiac arrest patients treated with targeted temperature management (TTM). Material and Methods: We systematically searched MEDLINE, EMBASE, and the Cochrane Library (search date: 9 July 2021) for studies on post-cardiac arrest patients treated with TTM that had measured the percent constriction of pupillary light reflex (%PLR) with quantitative pupillometry as well as assessed the neurological outcome. For an assessment of the methodological quality of the included studies, two authors utilized the prognosis study tool independently. Results: A total of 618 patients from four studies were included in this study. Standardized mean differences (SMDs) were calculated to compare patients with good or poor neurological outcomes. A higher %PLR measured at 0-24 h after hospital admission was related to good neurological outcomes at 3 months in post-cardiac arrest patients treated with TTM (SMD 0.87; 95% confidence interval 0.70-1.05; I-2 = 0%). A higher %PLR amplitude measured at 24-48 h after hospital admission was also associated with a good neurological outcome at 3 months in post-cardiac arrest patients treated with TTM, but with high heterogeneity (standardized mean difference 0.86; 95% confidence interval 0.40-1.32; I-2 = 70%). The evidence supporting these findings was of poor quality. For poor neurological outcome, the prognosis accuracy of %PLR was 9.19 (pooled diagnostic odds ratio, I-2 = 0%) and 0.75 (area under the curve). Conclusions: The present meta-analysis could not reveal that change of %PLR was an effective tool in predicting neurological outcomes for post-cardiac arrest patients treated with TTM owing to a paucity of included studies and the poor quality of the evidence.
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