Resuscitation plus最新文献

{"title":"Prognostic value of heart rate variability for neurological outcomes in cardiac arrest patients: machine learning-based analysis of the International Cardiac Arrest Research (I-CARE) database","authors":"Aman Liu , Xiao Chen , Xiaomeng Xu , Chong Li , Boda Zhou","doi":"10.1016/j.resplu.2026.101322","DOIUrl":"10.1016/j.resplu.2026.101322","url":null,"abstract":"<div><h3>Objective</h3><div>To predict neurological outcome of cardiac arrest patients who are in a comatose state, incorporating Heart Rate Variability (HRV) from electrocardiogram (ECG) signals to enhance prognostic value.</div></div><div><h3>Methods</h3><div>The International Cardiac Arrest Research (I-CARE) database which includes clinical information and continuous ECG data for 1020 patients aged 16 or older who were comatose after return of spontaneous circulation following cardiac arrest. We collected 86 HRV indicators from patients’ ECG readings, in addition to clinical parameters, to predict neurological outcome [categorized into good (Cerebral Performance Category (CPC) score 1–2) and poor (CPC score 3–5)]. Six machine learning models were constructed to predict neurological outcome, including logistic regression (LR), Random Forest (RF), Adaptive Boosting (Adaboost), Gradient Boost (GB), eXtreme Gradient Boosting (XGB), and Light GBM (LGB). A rigorous 5 repetitions of 10-fold cross-validation was implemented as the internal validation strategy on the training set to mitigate overfitting, and an ensemble model integrating these six validated algorithms was further explored. Twenty most important variables were identified using the Shapley method. The correlation between neurological outcomes and different HRV metrics were analyzed. Recursive feature elimination was applied to develop a clinical scoring system modified by HRV indicators.</div></div><div><h3>Results</h3><div>A total of 406 individuals with complete ECG & HRV data were included. We used 70% data as training set, with the rest 30% as test set. 5 × 10-fold cross-validation confirmed the robustness of all models, with the XGB model exhibiting a mean cross-validated AUROC of 0.7815 (95% CI: 0.657–0.886). The study demonstrated that the ensembled model, utilizing both clinical and HRV features, outperformed the model based solely on clinical parameters in eXtreme Gradient Boosting, Light GBM and Random Forest algorithms. The ensemble model exhibited the best performance in Light GBM algorithm (AUROC = 0.831; 95% CI 0.813–0.850), while HRV along exhibited an AUROC 0.809 (95% CI 0.792–0.825) in predicting neurological outcome in Gradient Boost algorithm. As to parameter analysis, Shapley’s method identified Perinatal Index, Triangular Index, Mean Circular Variance of NN Intervals as key HRV features in predicting neurological outcomes.</div></div><div><h3>Conclusions</h3><div>The integration of HRV features into machine learning models, combined with a rigorous internal cross-validation strategy, significantly enhanced prediction of neurological outcome in cardiac arrest. HRV features, alone or in combination with other clinical parameters, offered high interpretability and significant prognostic value in cardiac arrest. Future external validation in multicenter independent cohorts will further confirm the generalizability of these findings for clinical translation.</div></di","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101322"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147859021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased abdominal fat accumulation is associated with decreased survival to hospital admission in out-of-hospital cardiac arrest: a single center retrospective study","authors":"Yasutaka Koga ,&nbsp;Motoki Fujita ,&nbsp;Ryo Ayata ,&nbsp;Tomoaki Inoue ,&nbsp;Takeshi Yagi ,&nbsp;Masaki Todani ,&nbsp;Kotaro Kaneda ,&nbsp;Ryosuke Tsuruta","doi":"10.1016/j.resplu.2026.101343","DOIUrl":"10.1016/j.resplu.2026.101343","url":null,"abstract":"<div><h3>Objective</h3><div>The impact of obesity on outcomes after out-of-hospital cardiac arrest (OHCA) remains controversial. This study aimed to evaluate the association between abdominal fat accumulation, quantified by computed tomography (CT), and outcomes in patients with OHCA.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed adult patients with medical OHCA transported to our institution between June 2014 and May 2025. Patients with available abdominal CT scans were included regardless of return of spontaneous circulation (ROSC). The abdominal fat area (AFA) at the level of the third lumbar vertebra was measured on CT. Patients were divided into quartiles based on AFA, and their characteristics and outcomes were compared. The primary outcome was survival to hospital admission. Adjusted odds ratios (ORs) were calculated using multivariable logistic regression analyses.</div></div><div><h3>Results</h3><div>Among 788 adult patients with medical OHCA, 252 (32.0%) survived to hospital admission. Patients with lower AFA values were older and had smaller skeletal muscle areas. The group with the smallest AFA was less frequently classified as shockable or cardiogenic. Although this group achieved ROSC more often and earlier, survival to hospital admission did not differ significantly among the groups. However, logistic regression analysis showed that increased AFA was independently associated with lower odds of survival to hospital admission (adjusted OR 0.68 per 100 cm²; 95% CI 0.58–0.81). Greater AFA was also associated with poorer 30-day neurological outcomes and higher rates of intravenous cannulation failure by emergency medical services.</div></div><div><h3>Conclusions</h3><div>Greater abdominal fat accumulation was associated with reduced survival to hospital admission after OHCA.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101343"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147859066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neural regions associated with memories of Recalled Experiences of Death (REDs; authentic Near‑Death Experiences [NDEs]): a preliminary functional MRI study","authors":"José Alonso Ruiz ,&nbsp;Mayte Rodríguez-González-Moro ,&nbsp;Tomás Segura ,&nbsp;Víctor M. Serrano del Pueblo ,&nbsp;Salvador D. Aznar-Cervantes","doi":"10.1016/j.resplu.2026.101332","DOIUrl":"10.1016/j.resplu.2026.101332","url":null,"abstract":"<div><h3>Introduction</h3><div>This observational study examined brain activation patterns when people relive their memories of recalled experiences of death (REDs), also known as authentic near-death experience (NDE) memories, using structural and functional MRI under normal cerebral perfusion in participants with clinically documented life-threatening events and loss of consciousness.</div></div><div><h3>Methods</h3><div>Fifteen participants (7 women, 8 men; aged 18–75) were evaluated using two scanners. A block-design paradigm (recall RED–rest) was applied, with prior psychological training, physiological monitoring, and radiological review. Analysis was performed using SPM25. A whole-brain threshold was applied at an uncorrected level of <em>p</em> &lt; 0.001 with a minimum cluster extent of <em>k</em> ≥ 10 voxels. Region-of-interest (ROI) analyses were performed using small-volume correction with voxel-wise family-wise error (FWE) correction (pFWE &lt; 0.05).</div></div><div><h3>Results</h3><div>Significant activations were observed in the precuneus (BA7), posterior cingulate cortex (BA23/31), medial prefrontal cortex (BA10), dorsolateral prefrontal cortex (BA9/46), angular gyrus (BA39), secondary visual cortex (BA18/19), middle temporal gyrus (BA21), and orbitofrontal cortex (BA47). The parahippocampal region (BA36) showed a non-significant trend. No activation was found in primary sensorimotor or limbic areas.</div></div><div><h3>Discussion</h3><div>The reliving of RED/authentic NDE memories was associated with the engagement of brain networks implicated in autobiographical memory and the default mode network (DMN), suggesting the involvement of introspective and self-referential processes. The observed activation patterns were not consistent with those typically reported for primary sensory hallucinations.</div></div><div><h3>Conclusions</h3><div>Controlled reliving of memories of REDs/authentic NDEs may represent a useful experimental paradigm for investigating multisensory autobiographical memory and neural processes related to conscious self-experience. These findings are consistent with vivid episodic recollection and differ from neural patterns commonly associated with imagined or false memories.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101332"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147803196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A nationwide Scottish cohort study of the association between pre-existing mental illness and out-of-hospital cardiac arrest survival","authors":"Raied Alotaibi ,&nbsp;Nynke Halbesma ,&nbsp;Gareth Clegg ,&nbsp;Caroline A. Jackson","doi":"10.1016/j.resplu.2026.101218","DOIUrl":"10.1016/j.resplu.2026.101218","url":null,"abstract":"<div><h3>Aim</h3><div>To investigate the association between pre-existing mental illness and out-of-hospital cardiac arrest (OHCA) survival.</div></div><div><h3>Methods</h3><div>We performed a nationwide retrospective cohort study using Scottish Ambulance Service OHCA data linked to unscheduled care and death data in Scotland. We identified adults 18 years or older with non-traumatic OHCA between 2011 and 2022 and defined pre-existing mental illness as a record of mental illness within an unscheduled acute hospital admission or a record of unscheduled psychiatric hospital admission prior to OHCA. We used logistic regression models to obtain crude and adjusted odds ratios (ORs) for the association between mental illness and OHCA 30-day survival and conducted subgroup analyses based on patient and event characteristics, including age, sex, initial heart rhythm and bystander cardiopulmonary resuscitation.</div></div><div><h3>Results</h3><div>We included 30,523 patients with OHCA, of whom 12.8% had a pre-existing mental illness. Those with pre-existing mental illness had a higher prevalence of physical comorbidities, lower rates of initial shockable heart rhythm and significantly lower odds of 30-day survival compared to those without mental illness, after adjusting for age (OR 0.22, 95% confidence interval 0.18–0.26). This association persisted after adjusting the model for sex, year of arrest, comorbidities and deprivation, and was consistent across the different subgroups analysed.</div></div><div><h3>Conclusion</h3><div>Compared to people without pre-existing mental illness, those with pre-existing mental illness have lower odds of OHCA survival even after accounting for patient and event characteristics. Further research should investigate factors that may be responsible for this association and inform interventions to address disparities.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101218"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147803199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of establishing a new emergency and critical care center on regional out-of-hospital cardiac arrest transport patterns and outcomes","authors":"Ichiro Hirayama ,&nbsp;Minaho Nonaka ,&nbsp;Hiromu Naraba ,&nbsp;Tetsuhiro Yano ,&nbsp;Mitsuru Ishii ,&nbsp;Yoshiteru Tominaga","doi":"10.1016/j.resplu.2026.101336","DOIUrl":"10.1016/j.resplu.2026.101336","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrest (OHCA) outcomes are influenced by prehospital- and hospital-level factors. Transport to tertiary-level emergency and critical care centers (ECCCs) offering comprehensive post-cardiac arrest management improves survival; however, regional disparities exist. This study aimed to evaluate how establishing a new ECCC affects OHCA transport patterns and outcomes.</div></div><div><h3>Methods</h3><div>We conducted a study of 1497 patients with OHCA treated between 2019 and 2020 (pre-establishment) and between 2022 and 2023 (post-ECCC establishment) in a single regional emergency medical services system. Multinomial logistic regression was used to assess the association between transport distance and hospital destination, and multivariate logistic regression was used to identify factors associated with transport to the new ECCC. Subgroup analyses examined the return of spontaneous circulation (ROSC), 1-month survival, and favorable neurological outcomes (Cerebral Performance Category 1–2) in patients aged ≥65 years.</div></div><div><h3>Results</h3><div>After ECCC establishment, direct transport to the new ECCC increased across all distances, whereas transfers to secondary hospitals declined. Older patients (≥65 years) were more likely to be transported to the new ECCC, whereas traumatic cases were directed to pre-existing ECCCs (including trauma centers). ROSC at hospital arrival improved among older patients, but 1-month survival and favorable neurological outcomes did not significantly change.</div></div><div><h3>Conclusions</h3><div>The establishment of a new ECCC redistributed regional OHCA transport and improved access to ECCC care. Although ROSC improved in patients aged ≥65 years, this did not translate into better long-term or neurological outcomes, underscoring the need for optimized resuscitation strategies in aging populations.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101336"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147803234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and outcomes after out-of-hospital cardiac arrests in individuals with pre-existing psychiatric conditions, compared to those without","authors":"Linnea Gustafsson ,&nbsp;Anna Myredal ,&nbsp;Clara Hjalmarsson ,&nbsp;Lina Holmqvist ,&nbsp;Alfred Hjalmarsson ,&nbsp;Johan Herlitz ,&nbsp;Örjan Falk ,&nbsp;Antonia Panteli ,&nbsp;Araz Rawshani","doi":"10.1016/j.resplu.2026.101356","DOIUrl":"10.1016/j.resplu.2026.101356","url":null,"abstract":"<div><h3>Background/purpose</h3><div>Individuals with psychiatric conditions have increased cardiovascular morbidity and mortality, yet outcomes following out-of-hospital cardiac arrest (OHCA) in this population remain insufficiently characterized. We aimed to investigate the association between pre-existing psychiatric conditions and outcomes after OHCA in a nationwide Swedish cohort.</div></div><div><h3>Materials and methods</h3><div>We conducted a registry-based cohort study including all individuals ≥16 years with OHCA reported to the Swedish Registry for Cardiopulmonary Resuscitation (2010–2020). Psychiatric conditions were identified using ICD-10 codes and categorized into major diagnostic groups. The primary outcome was 30-day survival. Secondary outcomes included neurological status at discharge (CPC score) and long-term survival. Logistic regression models adjusted for age and sex were used, and analyses were stratified by initial rhythm.</div></div><div><h3>Results</h3><div>Among 53,981 individuals, 13,777 (26%) had a prior psychiatric diagnosis. Cardiac arrests in individuals with psychiatric conditions were less often witnessed and less likely to present with a shockable rhythm, despite similar rates of bystander CPR. Intoxication and suicide were markedly more common presumed causes, particularly among younger adults, in whom over half had a psychiatric diagnosis. Thirty-day survival was lower in individuals with psychiatric conditions (9% vs. 12%; adjusted OR 0.52, 95% CI 0.48–0.56). In stratified analyses, this association was evident in shockable but not non-shockable rhythms. Neurological outcomes among survivors were largely comparable.</div></div><div><h3>Conclusion</h3><div>Pre-existing psychiatric conditions are associated with lower survival after OHCA, largely driven by differences in arrest characteristics and etiology rather than bystander response. These findings highlight a vulnerable population and underscore the importance of targeted prevention and early recognition strategies. Keywords: Out-of-Hospital Cardiac Arrest (OHCA), Psychiatric diagnosis, Young Adults, 30-day survival, Swedish Cardiopulmonary Registry (SRCR), Emergency Medicine.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101356"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147995215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and preliminary validation of an explainable machine learning model for early ROSC detection during chest compression in a swine model of cardiac arrest","authors":"Jing Yang ,&nbsp;Jing Shi ,&nbsp;Hanqi Tang ,&nbsp;Xingliang Jin ,&nbsp;Fei Zhang ,&nbsp;Xinming Mei ,&nbsp;Wenlin Hao ,&nbsp;Ruoxue Wu ,&nbsp;Yan Li ,&nbsp;Huadong Zhu ,&nbsp;Shengyong Xu ,&nbsp;Jun Xu","doi":"10.1016/j.resplu.2026.101362","DOIUrl":"10.1016/j.resplu.2026.101362","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to develop a novel multi-parameter-based system for the early and accurate identification of restoration of spontaneous circulation (ROSC) during chest compression using a machine learning (ML) approach in cardiac arrest (CA) animal models.</div></div><div><h3>Methods</h3><div>Thirteen CA mini-swine models were established by inducing ventricular fibrillation, followed by cardiopulmonary resuscitation. Electrocardiograph (ECG), end-tidal carbon dioxide (ETCO₂), and photoplethysmography (PPG) waves were recorded during and after resuscitation. 75 non-ROSC segments (24,276 data points, each second generates a data point) and 52 ROSC segments (1416 data points) were recorded. Nine animal datasets were assigned to the training set, and four to the test set. Eight ML methods, including random forest (RF), support vector machine (SVM), decision trees (DT), neural networks (NNET), Naive Bayes (NB), Nearest neighbor (KNN), logistic regression (LR), and AdaBoost, were used to construct the model. Model performance was evaluated using multiple metrics, including the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive predictive value (PPV), F1-score, and leading time. The SHapley Additive exPlanation (SHAP) method was used to rank the feature importance and explain the final model.</div></div><div><h3>Results</h3><div>Among the eight ML models, the Adaboost model performed the best. The Adaboost model accurately identified ROSC without the interruption of chest compression [AUROC 0.891, sensitivity 0.813, specificity 0.957, PPV 0.929, F1-score 0.867 and leading time 18.2 s]. SHAP analysis identified the top dominant predictors of ROSC: ECG high-frequency energy, ECG mean slope, heart rate, respiration rate, perfusion index, and median ETCO₂.</div></div><div><h3>Conclusion</h3><div>A machine learning model integrating non-invasive ECG, ETCO₂, and PPG waveform parameters achieved reliable ROSC recognition during uninterrupted chest compression in animal models, with a detection time 18.2 s earlier than clinical judgment. The proposed model holds potential for future clinical translation and warrants further external validation in larger clinical studies.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101362"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resuscitation needs justice: an intersectional view on justice, equity, diversity, and inclusion","authors":"Olfa Chakroun-Walha ,&nbsp;Eve Kiebooms ,&nbsp;Sule Ozbilgin ,&nbsp;Sanin Bilic ,&nbsp;Jacques Delchef ,&nbsp;Cecilie Langkilde Lauesen ,&nbsp;Robert Greif ,&nbsp;Jacqueline Eleonora Ek","doi":"10.1016/j.resplu.2026.101347","DOIUrl":"10.1016/j.resplu.2026.101347","url":null,"abstract":"<div><div>Disparities in cardiac arrest survival persist across gender, race, age, disability, socioeconomic status, and geographical location in part due to unequal access to life-saving interventions such as bystander cardiopulmonary resuscitation (CPR) and early defibrillation. Inequities in access to training, equipment, and local implementation may reinforce these disparities across the chain of survival. Current diversity, equity and inclusion (DEI) approaches to disparities in resuscitation research often examine inequities in isolation, limiting their ability to explain how structural, social, and institutional factors interact to influence outcomes. To address these limitations, this concept paper proposes examining the chain of survival through an intersectional lens, which considers Justice at the forefront of Equity, Diversity, and Inclusion (JEDI). Adding justice as an ethical principle aims to target these broader factors, and when combined with DEI efforts, may lead to a more comprehensive approach on examining inequities in resuscitation. Within the European Resuscitation Council (ERC), this intersectional JEDI lens provides a support for identifying inequities and barriers across both the chain of survival and the formula of survival, including medical science, educational efficiency, and local implementation, so that giving and receiving high-quality resuscitation becomes realistically attainable for everyone.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101347"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147859077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced resuscitative interventions in refractory out-of-hospital cardiac arrest: a retrospective cohort study of a physician-led pre-hospital team","authors":"N. Kruit ,&nbsp;B. Burns ,&nbsp;I. Ferguson ,&nbsp;K. Fowler ,&nbsp;D. Tian ,&nbsp;M. Dennis","doi":"10.1016/j.resplu.2026.101331","DOIUrl":"10.1016/j.resplu.2026.101331","url":null,"abstract":"","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101331"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147859139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nucleated red blood cells as early predictors of poor neurological outcome after extracorporeal cardiopulmonary resuscitation: a retrospective dual-site cohort study of early laboratory markers","authors":"Julius Valentin Kunz ,&nbsp;Mareen Pigorsch ,&nbsp;Jens Nee ,&nbsp;Lilly Koppelkamm ,&nbsp;Teresa Carola Juchem ,&nbsp;Roland Körner ,&nbsp;Kai-Uwe Eckardt ,&nbsp;Philipp Enghard ,&nbsp;Jan Matthias Kruse ,&nbsp;Abakar Magomedov","doi":"10.1016/j.resplu.2026.101340","DOIUrl":"10.1016/j.resplu.2026.101340","url":null,"abstract":"<div><h3>Background</h3><div>Early neurological prognostication after extracorporeal cardiopulmonary resuscitation (ECPR) remains difficult. Common pre-cannulation markers such as lactate and pH offer limited accuracy for predicting neurological outcome. Nucleated red blood cells (NRBCs) increase under hypoxemia, yet their value as early predictors of adverse neurological outcome after ECPR has not been evaluated.</div></div><div><h3>Methods</h3><div>We performed a retrospective dual-site cohort study of adult patients who underwent ECPR for refractory circulatory arrest at Charité–Universitätsmedizin Berlin (2020–2024). Laboratory parameters obtained within six hours after admission were analyzed regarding their association with poor neurological outcome at discharge, defined as Cerebral Performance Category 3–5 or death before neuroprognostic assessment. Group differences were assessed using Cliff’s Δ, and discriminative performance was evaluated by receiver operating characteristic analysis. Poor neurological outcome served as the positive condition, with rule-in (≥90% specificity) and rule-out (≥90% sensitivity) thresholds.</div></div><div><h3>Results</h3><div>Among 197 patients (median age 55 years [IQR 46–61], 86.0% male), 38 (19.3%) had a good outcome and 159 (80.7%) a poor outcome. NRBCs/100 white blood cells (WBCs) showed the strongest association with outcome: patients with poor outcome had higher values (0.37 <em>n</em>/100 WBCs [0.18–0.72] vs. 0.19 <em>n</em>/100 WBCs [0.07–0.45]; Cliff’s Δ = 0.39, 95% CI 0.15–0.58). The area under the curve (AUC) was 0.70 [95% CI 0.59–0.80]. A rule-in threshold ≥0.54 <em>n</em>/100 WBCs (sensitivity 33%, specificity 93%) identified 42 true and only 2 false poor-outcome cases. Initial lactate (AUC 0.69 [0.59–0.80]) and pH (AUC 0.67 [0.55–0.79]) produced rule-in thresholds ≥18.4 mmol/L and ≤6.72, identifying 38 true vs. 3 false and 24 true vs. 2 false poor-outcome patients. WBCs, follow-up lactate, and phosphate were also associated with poor outcome. At rule-out thresholds, all markers performed poorly, with specificities of only 16–35% and frequent false-good classifications, underscoring the greater reliability of rule-in approaches.</div></div><div><h3>Conclusions</h3><div>NRBCs/100 WBCs measured within six hours after admission showed the best discriminatory ability for poor neurological outcome, outperforming lactate, pH, and other routine laboratory markers. NRBCs may represent a promising early indicator requiring prospective validation.</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"29 ","pages":"Article 101340"},"PeriodicalIF":2.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147859067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}