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Neurological pupil index during cardiopulmonary resuscitation is associated with admission to ICU in non-traumatic out-of-hospital cardiac arrest patients

  • Dong Won Kim1
  • You Hwan Jo2,3
  • Seung Min Park2,3
  • Dong Keon Lee2,3,*,†,
  • Dong-Hyun Jang4,*,†,

1Department of Emergency Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, 24253 Chuncheon, Republic of Korea

2Department of Emergency Medicine, Seoul National University Bundang Hospital, 13620 Seongnam, Republic of Korea

3Department of Emergency Medicine, Seoul National University College of Medicine, 03080 Seoul, Republic of Korea

4Department of Emergency Medicine, Korea University Anam Hospital, 02841 Seoul, Republic of Korea

DOI: 10.22514/sv.2022.038 Vol.19,Issue 2,March 2023 pp.48-54

Submitted: 16 December 2021 Accepted: 10 February 2022

Published: 08 March 2023

*Corresponding Author(s): Dong Keon Lee E-mail:
*Corresponding Author(s): Dong-Hyun Jang E-mail:

† These authors contributed equally.


Pupillary light reflex (PLR) is a simple method to assess brainstem function and can be measured objectively and accurately using pupillometry. We sought to investigate the relationship between PLR measured with pupillometry during cardiopulmonary resuscitation (CPR) and early prognosis of out-of-hospital cardiac arrest (OHCA) patients. This study was a single-centre prospective observational study. All OHCA patients who received CPR in the emergency department (ED) from August 2019 to January 2021 were registered, and adult patients whose neurological pupil index (NPi) was measured with an automated pupillometer during CPR in the ED were included. The primary outcome was admission to the intensive care unit (ICU). A total of 109 patients were included, and the mean of the NPi measurements of all the patients was 0.1 ± 0.7. The mean of the NPi was higher in the patients admitted to the ICU than in those who died in the ED, 0.5 ± 1.2 vs. 0.0 ± 0.1 (p = 0.031). Receiver operating characteristic analysis was performed to determine the cut-off value of the NPi, and the optimal cut-off value for ICU admission was 2.0 with sensitivity and specificity 0.769 and 0.652, respectively. Patients with NPi >2.0 showed higher rates of admission to ICU, ICU survival, and good neurologic outcomes at hospital discharge and at 3 months following cardiac arrest, than the patients with NPi ≤2.0. Firth’s bias-reduced penalised-likelihood multivariable logistic regression analysis showed that the odds ratio of the group with NPi >2.0 was 14.37 (95% confidence interval, 1.80–179.12), which was an independent variable associated with admission to ICU. NPi of higher than 2.0 is one of the indicators associated with an early favourable outcome of OHCA patients.


Pupillary reflex; Out-of-hospital cardiac arrest; Prognosis

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Dong Won Kim,You Hwan Jo,Seung Min Park,Dong Keon Lee,Dong-Hyun Jang. Neurological pupil index during cardiopulmonary resuscitation is associated with admission to ICU in non-traumatic out-of-hospital cardiac arrest patients. Signa Vitae. 2023. 19(2);48-54.


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