Abstract Details

Title Eye Movement and Coma Recovery after Cardiac Arrest

Topic Neuro Trauma and Critical Care

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 1-006

Objective To characterize eye movements in comatose patients after cardiac arrest (CA).

Background Most patients resuscitated from CA present with altered levels of consciousness due to brain injury. One potential marker of arousal recovery is evidence of eye movements. Brainstem pathways and thalamocortical projections responsible for eye movements share similar anatomic structures responsible for arousal. Our aim is to quantify eye movements using electro-oculography (EOG) data from patients presenting with CA.

Design/Methods

We are conducting a retrospective study of patients presenting within 24 hours of CA. We identify eye movements on EOG over a period of up to 72 hours, excluding periods of clinical care, sedation, and epileptiform activity. We will study the association of eye movement frequency and the following outcomes by two weeks: 1. Present corneal or pupillary reflex; 2. Eye opening (to stimuli or spontaneously); 3. Command following. Patients are excluded if they have ophthalmoplegia, dementia, or traumatic brain injury. We will compare eye movement frequency in our comatose cohort to a separate cohort of non-comatose patients who underwent sleep studies.

Results Our preliminary data consists of 100 patients, mean (± SD) age of 60.2 (± 15.3) years and 38% were female. By 2 weeks, 85% had a pupillary reflex, 75% had a corneal reflex, 43% opened eyes to stimuli, and 21% followed commands. Of 151.5 hours of EOG time across four patients, we preliminarily found eye movements present in 0.56% of total time, with a median of 0.73% and range of 0% to 2.29%. This is comparable to our cohort of 47 patients who underwent sleep studies, with eye movements present in 3.2% of N2, 2.9% of N3, and 19.8% of REM.

Conclusions Eye movements in comatose patients may be indicative of recovery potential. Understanding these differences could have prognostic significance and help in triaging care and family discussions.

Authors/Disclosures
Michael F. Cronin PRESENTER	The institution of Mr. Cronin has received research support from American Heart Association.
	No disclosure on file
Audrey S. Wack, MD	The institution of an immediate family member of Miss Wack has received research support from Canon Medical Systems USA, Inc.
	No disclosure on file
	No disclosure on file
David M. Greer, MD, FAAN (Boston University School of Medicine)	Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. An immediate family member of Dr. Greer has or had stock in Vertex Pharmaceuticals. The institution of Dr. Greer has received research support from NINDS. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has a non-compensated relationship as a Treasurer-Elect with American Neurological Association that is relevant to AAN interests or activities. Dr. Greer has a non-compensated relationship as a President with Neurocritical Care Society that is relevant to AAN interests or activities.
Charlene J. Ong, MD (Boston University)	Dr. Ong has nothing to disclose.

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