Prognostic value of pupillometry in patients with ROSC after OHCA
Research type
Research Study
Full title
The prognostic value of pupillometry in patients with return of spontaneous circulation after out-of-hospital cardiac arrest
IRAS ID
220061
Contact name
Alastair Proudfoot
Contact email
Sponsor organisation
Barts Health NHS Trust
Duration of Study in the UK
1 years, 6 months, 1 days
Research summary
Research Summary:
Cardiac arrest describes sudden cessation of heart function. Each year about 30,000 people receive resuscitation for an Out of Hospital Cardiac Arrest (OHCA) in the UK. Only 1/20 people that have an OHCA survive to go home from hospital; in 2/3 patients this is because of brain damage caused by lack of blood flow to the brain during the cardiac arrest.
Following cardiac arrest, we would like to be able to predict which patients are likely to recover and which will suffer untreatable brain damage. This will help guide doctors in updating family members about relatives at an earlier stage of their illness and will help us to decide when invasive supportive techniques likely to make a difference to survival.
There are several ways of predicting brain damage following OHCA including examination, x-ray images of the brain as well as tests of brain electrical activity. These are inaccurate, impossible to do at the bedside and are influenced by medications. Measurement of how the pupils respond to a bright light (pupillometry) can be done by a hand held device and may provide valuable information about patients’ prospects of recovery. We will test the response of the eyes to light at specific time points over the first 2 days, in patients who are admitted following OHCA. In patients who survive to go home, we will also make an assessment of how well their brain is functioning.
The information may give us a better understanding of the role of pupillometry in establishing which patients who survive OHCA will recover brain function. This may allow us to provide better care to patients likely to survive with good brain function and give early information to families about patients who are unlikely to recover brain function or who may die as a result of brain damage.
Summary of results:
Our study aimed to understand the value of early detailed reflex in predicting neurological recovery in patients admitted following out-of-hospital cardiac arrest (OHCA).Methods
We undertook a study at a single site in London of patients following OHCA whose heart restarted but remained unconcsious. We used a device to measure the light reflexes of the eye at ifferent time points to see if and how this related to the recovery of their brain function at hospital discharge.
Results
77 patients were included, of whom 34% of patients survived to hospital discharge with good brain function. A low level of light reflex measured by an algorithm in the device in the first 24 hours after OHCA accurately predicted poor brain recovery following OHCA.
REC name
London - Harrow Research Ethics Committee
REC reference
18/LO/0008
Date of REC Opinion
29 Mar 2018
REC opinion
Further Information Favourable Opinion