Department of Emergency Medicine, College of Medicine, Hallym University, Chuncheon 24253, Korea.
Department of Emergency Medicine, Hanyang University College of Medicine, Seoul 04763, Korea.
Medicina (Kaunas). 2022 Jun 15;58(6):804. doi: 10.3390/medicina58060804.
: 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). : 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. : 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 = 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 = 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 = 0%) and 0.75 (area under the curve). : 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.
: 本研究旨在评估定量瞳孔光反射作为接受目标温度管理（TTM）治疗的心脏骤停后患者神经预后的预测工具的有效性。 : 我们系统地检索了 MEDLINE、EMBASE 和 Cochrane 图书馆（检索日期：2021 年 7 月 9 日），以寻找关于接受 TTM 治疗的心脏骤停后患者的研究，这些研究使用定量瞳孔计测量了瞳孔光反射的收缩百分比（%PLR），并评估了神经预后。为了评估纳入研究的方法学质量，两名作者独立使用预后研究工具进行评估。 : 共有来自四项研究的 618 名患者纳入本研究。计算标准化均数差（SMD）以比较神经结局良好或不良的患者。TTM 治疗的心脏骤停后患者在入院后 0-24 小时测量的较高 %PLR 与 3 个月时的良好神经结局相关（SMD 0.87；95%置信区间 0.70-1.05；I = 0%）。入院后 24-48 小时测量的较高 %PLR 幅度也与 TTM 治疗的心脏骤停后患者 3 个月时的良好神经结局相关，但存在高度异质性（SMD 0.86；95%置信区间 0.40-1.32；I = 70%）。支持这些发现的证据质量较差。对于神经结局不良，%PLR 的预后准确性为 9.19（合并诊断比值比，I = 0%）和 0.75（曲线下面积）。 : 由于纳入研究较少且证据质量较差，本荟萃分析无法表明 %PLR 的变化是预测接受 TTM 治疗的心脏骤停后患者神经预后的有效工具。
