Radiologic Eye Deviation as a Prognostic Marker in Patients Post-Cardiac Arrest: A Retrospective Observational Study

Eye deviation is recognized as a clinical indicator of brain function in acute brain injury. This study investigated the association between radiologic eye deviations on brain computed tomography (CT) and neurological outcomes in post-cardiac arrest patients.

This single-center, retrospective observational study included adult patients with out-of-hospital cardiac arrest (OHCA) of presumed medical cause who achieved return of spontaneous circulation (ROSC) and underwent brain CT within 24 hours, between January 2012 and December 2022. Radiologic lateral eye deviation angles were quantitatively measured on brain CT images. Multivariate logistic regression was conducted to identify independent predictors of poor neurological outcome at hospital discharge and inhospital mortality. Receiver operating characteristic curve analysis evaluated diagnostic performance of eye deviation angles and serum biomarkers.

Among 141 patients, 127 had poor neurological outcomes. Non-conjugate eye deviation was more common in the poor outcome group (71.7% vs. 42.9%) and showed a significant association in univariate analysis (OR 3.37, 95% CI 1.10-10.90; p = 0.035), but lost significance after multivariate adjustment. The diagnostic accuracy of the conjugate eye deviation angle was modest (AUC 0.611) and inferior to serum S-100B protein (AUC 0.790).

Radiographic eye deviation on brain CT alone is insufficient to reliably predict neurological outcomes after cardiac arrest. Further large-scale studies incorporating multimodal approaches are needed to clarify its prognostic utility.