Association of prehospital pupillary diameter with return of spontaneous circulation and neurological outcome after out-of-hospital cardiac arrest: A multicenter retrospective analysis
Year: 2025
Type: article
Abstract: Background: In Japan, emergency medical services (EMS) routinely record pupillary size and pupillary light reflex (PLR) during prehospital care for out-of-hospital cardiac arrest (OHCA). While hospital-based studies have established the prognostic value of pupillary findings, the significance of prehospital pupillary diameter remains uncertain. Objective: To examine whether pupillary diameter at EMS contact predicts prehospital return of spontaneous circulation (ROSC) and 30-day neurological outcomes. Methods: This retrospective cohort study analyzed SOS-KANTO 2017, a prospective multicenter OHCA registry. Of 9909 adults, 8494 were eligible after excluding those not in arrest at EMS contact or with missing data. EMS personnel, trained in neurological assessment, documented pupillary diameter using standardized visual charts (0.5-mm increments) but recorded registry values in 1-mm categories (1-8 mm). The primary outcome was prehospital return of spontaneous circulation (ROSC), and the secondary outcome was 30-day favorable neurological status (CPC 1-2). Multivariable logistic regression adjusted for demographics, resuscitation factors, and Utstein variables. Receiver operating characteristic (ROC) analyses, treating failure to achieve ROSC as the positive condition, were performed to assess sensitivity, specificity, and false positive rate (FPR) for futility thresholds. Results: < 0.001). Thresholds of ≥7-8 mm predicted failure to achieve ROSC with high specificity (0.93-0.99) but poor sensitivity. Conclusions: Prehospital pupillary diameter is independently associated with both ROSC and 30-day neurological outcome. Although extreme dilation (≥7-8 mm) provides a highly specific marker of futility, low sensitivity precludes its use as a stand-alone criterion. Pupillary assessment may nonetheless contribute, in combination with other prehospital indicators, to a multimodal framework for early decision-making.
Source: Resuscitation Plus
Institution: Tokyo Women's Medical University
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,450
Funders: Nihon University, National Center for Child Health and Development, Organ and Tissue Authority, Teikyo University School of Medicine, Keio University, Dokkyo Medical University, Jichi Medical University, University of Tokyo, Juntendo University, Gunma University, Tokyo Medical and Dental University, Chiba University, Tokyo Women's Medical University, School of Medicine, Tokai University
OpenAlex ID: W4414571971