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Cardiac Arrest and Postcardiac Arrest Care: State of the Art and Future Directions

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: 10 February 2027 | Viewed by 3210

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Editors

Dr. Jae-Hyug Woo

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Guest Editor

Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, 24, Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Republic of Korea
Interests: out-of-hospital cardiac arrest; cardiopulmonary resuscitation; postcardiac arrest syndrome; postcardiac arrest care; survival; neurologic outcomes

Dr. Soheil Saadat

E-Mail Website
Guest Editor

Department of Emergency Medicine, University of California, Irvine, CA 92697, USA
Interests: educational research; clinical epidemiology; injury prevention; health care quality assessment; public health; social determinants of health

Special Issue Information

Dear Colleagues,

The field of cardiopulmonary resuscitation (CPR) and postcardiac arrest care continues to advance. However, some aspects of cardiac arrest management still lack robust scientific evidence yet are applied in clinical practice, and many areas remain under active investigation. Moreover, since relatively few studies have focused exclusively on patients with cardiac arrest, much of their management in the ICU continues to rely on evidence derived from general critical care.

The Special Issue “Cardiac Arrest and Postcardiac Arrest Care: State of the Art and Future Directions” will focus on the following topics:

Postcardiac Arrest Syndrome;
Postcardiac Arrest Care in the ICU;
Targeted Temperature Management;
Strategies to improve survival and neurological outcomes after the return of spontaneous circulation (ROSC).

We sincerely welcome contributions from leading experts in the field of resuscitation and look forward to receiving cutting-edge research exploring the topics outlined above.

Dr. Jae-Hyug Woo
Dr. Soheil Saadat
Guest Editors

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Keywords

out-of-hospital cardiac arrest
cardiopulmonary resuscitation
postcardiac arrest syndrome
postcardiac arrest care
survival
neurologic outcomes

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Published Papers (4 papers)

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Research

13 pages, 2132 KB

Open AccessArticle

Hyperacute Cytokine Kinetics and Early Interleukin-10 Elevation as Predictors of Neurological Outcome in Post-Cardiac Arrest Syndrome

by Jea Hun Oh, Hyo Joon Kim, Kyung Man Cha, Daehee Kim, Kiwook Kim, In Soo Kim, Ji Hoon Kim, Chun Song Youn, Sang Hoon Oh, Hyo Jin Bang, Ae Kyung Gong and Ji Sook Lee

J. Clin. Med. 2026, 15(16), 6376; https://doi.org/10.3390/jcm15166376 - 18 Aug 2026

Viewed by 166

Abstract

Background: Post-cardiac arrest syndrome (PCAS) involves a complex interplay between systemic inflammatory and compensatory anti-inflammatory responses. The hyperacute kinetics of these cytokines and their incremental prognostic value beyond established brain injury biomarkers remain inadequately characterized. We aimed to evaluate whether the 6 h post–return-of-spontaneous-circulation (ROSC) cytokine profile predicts neurological outcome, with the Th1/Th2 ratio largely reflecting the IL-10 signal. Methods: This retrospective analysis of prospectively collected data from a single-center cardiac arrest registry included 56 cardiac arrest survivors (40 out-of-hospital, 16 in-hospital) treated with targeted temperature management (TTM) at 33 °C or 36 °C between January 2024 and December 2025. Serum IL-6, IL-10, IFN-γ (interferon-γ), and TNF-α (tumor necrosis factor-α) were measured at five time points (initial presentation (INIT), and 6, 24, 48, and 72 h post-ROSC). Neurological outcome was assessed using the Cerebral Performance Category (CPC) scale at 6 months after cardiac arrest, with poor outcome defined as CPC 3–5. Results: Eighteen patients (32.1%) had a good outcome (CPC 1–2) and 38 (67.9%) had a poor outcome at 6 months after cardiac arrest. Among the 38 poor-outcome patients, 2 were classified as CPC 3, 8 as CPC 4, and 28 as CPC 5 (death) at 6 months; the 6-month outcome was available for all 56 patients, with no loss to follow-up. Patients with poor outcomes exhibited a synchronized surge of IL-6 and IL-10 peaking at 6 h post-ROSC. IL-10 at 6 h showed the highest discriminative power among cytokines (area under the curve (AUC) 0.844) compared with IL-6 (AUC 0.761). Multivariable analysis using Youden-derived cut-offs revealed that IL-10 ≥ 154.32 pg/mL (adjusted odds ratio (aOR) 15.28, 95% CI 2.02–115.38, p = 0.008) and a Th1/Th2 ratio ≥ 0.0314 (aOR 0.09, 95% CI 0.01–0.61, p = 0.013) were independently associated with neurological outcome after adjustment for age and initial shockable rhythm. Conclusions: The 6 h post-ROSC window is a critical inflection point for immune dysregulation in PCAS. Early IL-10 elevation and collapse of the Th1/Th2 balance are independently associated with poor neurological recovery and add incremental prognostic information to established brain injury biomarkers. External validation in larger prospective cohorts is required. Full article

(This article belongs to the Special Issue Cardiac Arrest and Postcardiac Arrest Care: State of the Art and Future Directions)

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11 pages, 361 KB

Open AccessArticle

Association of Serial Lactate-to-Albumin and C-Reactive Protein-to-Albumin Ratios with In-Hospital Mortality After Out-of-Hospital Cardiac Arrest

by Wan Young Heo, Dong Hun Lee, Seok Jin Ryu, Byung Kook Lee, Yong Hun Jung and Kyung Woon Jeung

J. Clin. Med. 2026, 15(13), 4851; https://doi.org/10.3390/jcm15134851 - 23 Jun 2026

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Abstract

Background: The lactate-to-albumin ratio (LAR) and C-reactive protein-to-albumin ratio (CAR) are biomarkers for metabolic stress and inflammation. However, their prognostic significance after return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) remains unclear. Therefore, this study aims to investigate the association between serial LAR/CAR measurements and in-hospital mortality. Methods: This retrospective observational cohort study included adult comatose patients with OHCA treated with targeted temperature management between January 2022 and December 2025. Serum lactate, albumin, and C-reactive protein levels were measured at admission and at 24, 48, and 72 h after ROSC. The primary outcome was in-hospital mortality. Multivariable logistic regression analyses were performed to assess independent associations of LAR and CAR with in-hospital mortality, and discriminatory performance was assessed using the area under the receiver operating characteristic curve (AUC). Results: Of the 284 eligible patients, 253 were included in the final analysis. Of these, 80 patients died in hospital, corresponding to an in-hospital mortality rate of 31.6%. LAR and CAR were significantly higher in non-survivors than in survivors at admission and at 24, 48, and 72 h after ROSC. After adjustment for potential confounders, LAR was associated with in-hospital mortality at all assessed time points. CAR was independently associated with in-hospital mortality at admission and at 48 and 72 h after ROSC, but not at 24 h. The AUCs of LAR for predicting in-hospital mortality ranged from 0.702 to 0.734, whereas those of CAR ranged from 0.640 to 0.690. Conclusions: In this single-center retrospective cohort of post-ROSC OHCA patients, sequential tracking of LAR and CAR profiles during the first 72 h after ROSC provided meaningful insights into in-hospital mortality. LAR showed a more consistent independent association with mortality and fair discriminatory performance, whereas CAR demonstrated limited prognostic value despite its association with mortality. Full article

(This article belongs to the Special Issue Cardiac Arrest and Postcardiac Arrest Care: State of the Art and Future Directions)

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9 pages, 774 KB

Open AccessArticle

Incremental Value of Adding S100B to NSE for High-Specificity Rule-in of Poor Neurological Outcome After Out-of-Hospital Cardiac Arrest

by Seokjae Hong, Seungho Lee, Jung Soo Park, Jin Hong Min, Changshin Kang and Byung Kook Lee

J. Clin. Med. 2026, 15(8), 3043; https://doi.org/10.3390/jcm15083043 - 16 Apr 2026

Cited by 1 | Viewed by 578

Abstract

Background: We evaluated whether adding S100B to NSE improved discrimination or high-specificity rule-in of poor neurological outcome after out-of-hospital cardiac arrest (OHCA). Methods: In this single-center retrospective cohort study, comatose adult OHCA survivors treated with targeted temperature management had NSE and S100B measured at 0, 24, 48, and 72 h after return of spontaneous circulation. At each time point, we assessed NSE alone, S100B alone, and a logistic model combining both biomarkers in paired complete cases. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Rule-in performance was evaluated using a timepoint-specific threshold that achieved 100% specificity in our cohort. Poor neurological outcome was defined as cerebral performance category 3–5 at 6 months. Results: Among 124 patients, 66 (53.2%) had poor outcomes. AUCs were similar between NSE alone and the combination across all time points (all p > 0.3). At 48 h, the combination ruled in 46/65 (70.8%) patients with poor outcome versus 36/65 (55.4%) with NSE alone, identifying 10 additional patients and a 15.4-percentage-point difference (95% confidence interval, −5.6 to 23.6). Conclusions: Adding S100B to NSE did not improve overall discrimination. The higher 48 h rule-in yield was estimated imprecisely and should be interpreted cautiously. Our findings require external validation before they can be translated to clinical settings. Full article

(This article belongs to the Special Issue Cardiac Arrest and Postcardiac Arrest Care: State of the Art and Future Directions)

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11 pages, 731 KB

Open AccessArticle

Distinct Coagulation Phenotypes and Long-Term Neurological Outcomes in Post-Cardiac Arrest Syndrome: A Latent Class Analysis of a 9-Year Single-Center Cohort

by Sin Young Park, Sang Hoon Oh, Hyo Joon Kim, Han Joon Kim and Jee Yong Lim

J. Clin. Med. 2026, 15(3), 1287; https://doi.org/10.3390/jcm15031287 - 5 Feb 2026

Viewed by 798

Abstract

Background/Objectives: Post-cardiac arrest syndrome (PCAS) induces systemic ischemia–reperfusion injury accompanied by sepsis-like coagulopathy. This coagulopathy presents heterogeneously, yet distinct coagulation phenotypes and their impact on hypoxic–ischemic brain injury (HIBI) remain poorly defined. We aimed to identify coagulation phenotypes using latent class analysis (LCA) and assess their association with 6-month neurological outcomes. Methods: We retrospectively analyzed adult out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM) between 2011 and 2019 from a prospective registry at a tertiary academic center. LCA was performed using coagulation biomarkers measured at admission and 24 h post-return of spontaneous circulation: D-dimer, fibrinogen, antithrombin III (ATIII), platelet count, and PT-INR. The primary outcome was poor neurological outcome (Cerebral Performance Category 3–5) at 6 months. Secondary outcomes included in-hospital mortality and cerebral edema severity assessed by gray-to-white matter ratio (GWR) on brain CT. Results: Among 325 patients, LCA identified three phenotypes: Class 1 (Preserved Coagulation, 36.9%), Class 2 (Hypercoagulable State, 41.5%) characterized by elevated D-dimer with preserved fibrinogen and ATIII, and Class 3 (Consumptive Coagulopathy, 21.5%) marked by profound D-dimer elevation with fibrinogen <150 mg/dL and ATIII <60%. Class 3 exhibited the lowest GWR and highest neuron-specific enolase levels. In multivariable analysis adjusting for age, low-flow time, initial rhythm, and lactate, Class 3 independently predicted poor neurological outcome (adjusted OR 4.52; 95% CI 2.15–9.48), whereas Class 2 did not. Conclusions: PCAS-related coagulopathy is heterogeneous. A consumptive coagulopathy phenotype identifies a high-risk subgroup associated with severe brain injury and poor long-term neurological outcomes. Early identification of this phenotype may enable targeted prognostication and guide future phenotype-specific interventional strategies.: Full article

(This article belongs to the Special Issue Cardiac Arrest and Postcardiac Arrest Care: State of the Art and Future Directions)

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