• Hui Jai Lee, Jonghwan Shin, Ki Jeong Hong, Jin Hee Jung, Se Jong Lee, Euigi Jung, Kyoung Min You, and Tae Han Kim.
• Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Republic of Korea.
• Resuscitation. 2019 Feb 1; 135: 80-87.

PurposeWe investigated the change in pupil size and pupil light reflex (PLR) using a pupillography capable of continuous measurement both during CPR and immediately following the return-of-spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) comatose patients in an emergency department.MethodsPupil size and PLR were continuously measured both during CPR and immediately following ROSC until intensive care unit (ICU) admission. The changes in pupil sizes during CPR were categorized into three groups (no change - N, decreased - D, and increased - I groups).ResultsPupillography was applied for 118 and 60 patients during CPR and immediately following ROSC, respectively. Only two patients had a PLR during CPR. The number of patients included each group were 58 (N-group), 21 (D-group) and 39 (I-group). In the D-group, the proportion of witnessed arrest was higher than in the N-group and I-group (81% vs. 55% and 49%, respectively; p = 0.049). There were statistically significant shorter prehospital time in the D-group than the N-group and I-group (13 vs. 23 and 24 min, respectively; p = 0.012). PLR was observed immediately following ROSC in 14 patients. PLR was maintained in seven of these patients until admission to intensive care unit. Six of the seven patients who remained with PLR until ICU admission had survival to hospital discharge, and three of them had good neurological recovery.ConclusionOur study demonstrated that measurement of the continuous pupillary response can be feasible. Patients with the presence of PLR following ROSC had better outcomes.Copyright © 2018 Elsevier B.V. All rights reserved.

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