Neuroprognostication with quantitative pupillometry
After cardiac arrest, pupillary reactivity is one of the strongest predictors of neurological outcome. Quantitative measurement removes the subjectivity that undermines this critical assessment.
The prognostication challenge
Post-cardiac arrest care involves a critical prognostication decision: will this patient recover neurological function? The European Resuscitation Council and American Heart Association both recommend pupillary reactivity assessment as part of multimodal neuroprognostication.
However, manual pupil assessment during targeted temperature management (TTM) is particularly unreliable. Hypothermia slows pupillary reflexes, and sedation confounds clinical assessment. The margin between 'reactive' and 'non-reactive' becomes impossibly narrow for the human eye.
Automated quantitative pupillometry addresses this directly: it detects pupillary reactivity that is invisible to the naked eye, providing an objective data point for the prognostication algorithm.
Objective data for life-or-death decisions
PupiLUX provides quantitative bilateral pupil measurements that detect subtle reactivity even during therapeutic hypothermia. The 6-parameter profile gives clinicians granular data beyond binary reactive/non-reactive.
- Detects subtle reactivity that penlight assessment misses
- Constriction percentage (CP) quantifies the degree of reactivity
- Bilateral measurement with RAPD scoring for asymmetry
- Serial measurements track trajectory over hours
- PDF report provides documented evidence for family discussions
- Reproducible across nursing shifts — same test, same parameters
Key Evidence
Quantitative pupillometry (NPi) detected pupillary reactivity in 16% of patients classified as 'non-reactive' by standard manual assessment, potentially changing prognostic classification.
Oddo M, Sandroni C, Citerio G, et al.. “Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients” Resuscitation, 2018.
NPi ≤ 2 at 24 hours post-arrest had 100% specificity for poor neurological outcome, with no false positives.
Solari D, Rossetti AO, Oddo M, et al.. “Early prediction of coma recovery after cardiac arrest with blinded pupillometry” Ann Neurol, 2017.
Bilateral absence of pupillary light reflex at 72 hours is one of the most reliable predictors of poor outcome (FPR 0%).
Sandroni C, Cariou A, Cavallaro F, et al.. “Prognostication in comatose survivors of cardiac arrest: an advisory statement from the ERC-ESICM” Intensive Care Med, 2014.
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Frequently Asked Questions
Can PupiLUX be used during targeted temperature management?
Yes. Quantitative pupillometry is specifically recommended during TTM because it detects subtle reactivity that manual assessment misses in hypothermic patients.
At what timepoint should pupillometry be performed post-arrest?
Current guidelines recommend quantitative pupillometry at 24-72 hours post-arrest as part of multimodal neuroprognostication. Serial measurements provide trajectory data.
Does PupiLUX replace other prognostic tools?
No. PupiLUX provides one component of multimodal neuroprognostication. Quantitative pupillometry data should be interpreted alongside EEG, somatosensory evoked potentials, biomarkers, and neuroimaging.
PupiLUX is not a diagnostic device. For informational and screening purposes only. All clinical decisions must be made by qualified healthcare professionals.