Cardiac arrest frequently leads to devastating neurologic outcomes, yet current prognostic tools frequently fail to distinguish recovery potential. EOG is a low-cost, non-invasive tool routinely used in post-arrest care. While decreased reflexive and voluntary eye movements have been linked with poor neurologic outcomes, the prognostic utility of quantitative eye movements measured using EOG is unestablished.

We performed a retrospective, single-center cohort study including adults who experienced cardiac arrest and underwent EOG in the intensive care unit between 2016 and 2023. The primary exposure was average hourly eye movements at 48-96 hours post-arrest, quantified using an automated EOG algorithm. The primary outcome was modified Rankin Scale (mRS) score at discharge, dichotomized as poor (mRS >4) vs. good (mRS ≤4). Associations between eye movements and outcome were evaluated using logistic regression.

A total of 169 patients were included. The median age was 55 [43, 61] and 105 (62.1%) were male. At discharge, 23 patients (13.7%) had mRS ≤4. At 48-96 hours post-arrest, patients with good outcome had higher average hourly eye movements than those with poor outcome (478.4 ± 331.0 vs. 180.8 ± 210.0; Wilcoxon rank-sum test, p<0.001). After adjusting for age and sex, each one-SD (SD=463) increase in average hourly eye movements at 48-96 hours post-arrest was associated with increased odds of good outcome (OR=1.93, 95% CI 1.20-3.27). A sensitivity analysis using data 0-24 hours post-arrest showed a similar but not statistically significant trend (OR=1.88, 95% CI 0.81-4.02).