Early Neurological Pupil Index Assessment to Predict Outcome in Cardiac Arrest Patients Undergoing Extracorporeal Membrane Oxygenation

Hypoxic-ischemic brain injury is the main cause of death or disability in patients resuscitated from cardiac arrest (CA).1 Veno-arterial extracorporeal membrane oxygenation (VA ECMO) may be used as a mechanical support for refractory CA or post-CA cardiogenic shock. However, the potential benefit of this resource-intensive treatment should be balanced against the risk of futility. In a recent multicenter study,2 absence of pupillary reactivity detected using automated pupillometry (AP) showed to accurately predict hypoxic-ischemic brain injury outcome at 24–48 hours from CA. However, no data on the role of AP on admission (i.e., earliest timing for prognostication) in ECMO patients (i.e., the sickest population) are currently available. This post hoc analysis aimed to assess the accuracy of early AP for outcome prediction in CA patients undergoing ECMO.