Right eye green
Left eye yellow

One unit decrease in NPI, deterioration to 0, two consecutive NPI readings zero are all associated with higher risk of mortality

Assoc with higher risk mortality

• One unit decrease in NPI
• Deterioration in NPI to 0
• Two consecutive NPI readings 0

Measured Value	Assessment
3.0 - 4.9	Normal
< 3.0	Abnormal
0	Non-reactive, immeasurable, or atypical response

A difference in NPi between right and left pupils of = 0.7 can also be considered an abnormal pupil reading.
Note: this is true even if both sizes are > 3.

Cardiac arrest

• NPi was 100% specific to predict an unfavorable outcome at 3 months.
• 100% of pts with even one NPi reading of ≤ 2 had an unfavorable outcome.
• At 6 hrs post-ROSC, NPi predicted poor clinical outcomes.
• Best predictor of poor outcome in first 6 h after ROSC was an NPI < 3.7.
• Pupil size did not predict.

ECMO

• Abnormal NPi (< 3, at any time from 24-72 hr) was 100% specific for 90-day mortality with 0% false positives.