Background: Poor neurological recovery after in-hospital cardiac arrest (IHCA) may be exacerbated by postresuscitation myocardial dysfunction. However, the predictive value of left ventricular ejection fraction (LVEF) for neurological outcomes remains insufficiently explored.

Methods: This retrospective study included patients with IHCA who achieved return of spontaneous circulation at the Zigong Fourth People’s Hospital between 2019 and 2024. Neurological function at discharge was evaluated using the cerebral performance category (CPC) score (favorable: CPC ≤ 2; unfavorable: CPC > 2). Multivariable logistic regression, restricted cubic splines, and receiver operating characteristic curves were used to evaluate the predictive performance. The incremental value of LVEF was assessed using net reclassification improvement and integrated discrimination improvement. Decision and calibration curves were used to assess clinical utility.

Results: Of the 179 patients, 31 (17.3%) exhibited favorable neurological outcomes. After adjusting for mechanical ventilation and consciousness levels, LVEF remained an independent predictor of favorable recovery (odds ratio: 1.057; 95% confidence interval [CI]: 1.005–1.112; P = 0.032). Restricted cubic splines analysis demonstrated a linear dose–response relation between LVEF and favorable outcomes (P for nonlinearity = 0.984). The integrated model incorporating LVEF, cardiac arrest survival postresuscitation in-hospital, and modified early warning score yielded an area under the curve of 0.869 (95% CI: 0.803–0.935). Bootstrap analysis identified an optimal LVEF threshold of 58% (95% CI: 55%–65%). The addition of LVEF to conventional scoring systems improved both the net reclassification improvement and integrated discrimination improvement ( P < 0.05), with the decision curve analysis confirming an enhanced net clinical benefit. Calibration curves showed good agreement between the predicted and observed outcomes.

Conclusion: Bedside ultrasonographic assessment of LVEF is an independent linear predictor of neurological recovery in patients with IHCA. Incorporating LVEF into existing clinical frameworks (cardiac arrest survival postresuscitation in-hospital and modified early warning score) enhances the prognostic accuracy and risk stratification, providing objective evidence for early clinical decision-making.

Background:Early neuroprognostication after cardiac arrest (CA) remains challenging. Manual pupillary light reflex assessments can be inconsistent, leading to interest in automated, quantitative pupillometry. This study used the better Neurological Pupil Index (NPi) and pupillary percentage values from bilateral measurements for neuroprognostication following CA.

Methods:We evaluated 90 adult survivors of in- and out-of-hospital CA admitted to a medical ICU at a tertiary care university hospital in Berlin. Automated pupillometry was performed every 8 hours for 5 days post-admission using the NeurOptics NPi-100 pupillometer. The better measurement from either eye was selected for analysis. Outcomes at hospital discharge were classified as good (cerebral performance category scale [CPC] 1–2) or poor (CPC 3–5) using the Pittsburgh CPC scale.

Results:Patients with favorable neurological outcomes consistently showed higher NPi values (P < 0.001) and greater percentage changes in pupillary diameter (P < 0.001). At 72 hours, the median NPi was significantly higher in the good outcome group (4.7 [interquartile range (IQR), 4.5–4.8] vs. 4.1 [IQR, 3.7–4.5]; P < 0.05). However, NPi values overlapped between groups, and most patients with unfavorable outcomes still exhibited values within the normal range (NPi > 3.0). A receiver operating characteristic analysis of the pupillary percentage change revealed a threshold of 16% to discriminate between the prespecified outcome groups.

Conclusion:Higher NPi values and/or greater pupillary diameter changes of the better reading in bilateral measurements were associated with favorable neurological outcomes after CA. However, previously proposed cutoff thresholds could not be confirmed in our cohort.

Background:Cardiac arrest is a critical clinical condition with a grave prognosis, imposing a substantial burden on healthcare resources and society. Its underlying pathophysiology is characterized by the abrupt cessation of cardiac pump function, leading to systemic ischemia and hypoxia, particularly in the brain. This ischemic insult, in turn, activates a potent systemic inflammatory response that exacerbates organ injury. Conventional clinical parameters often fall short in providing a multidimensional assessment that concurrently addresses both inflammatory and ischemic-hypoxic risks, thereby limiting the identification of high-risk patients. The hemoglobin-to-red cell distribution width ratio (HRR) has recently emerged as a novel and integrated biomarker capable of reflecting systemic inflammatory activity and ischemic-hypoxic status. Although its prognostic value has been validated in various diseases, evidence regarding its association with outcomes following in-hospital cardiac arrest resuscitation remains scarce. Furthermore, existing studies predominantly focus on 30-day outcomes, leaving its role in predicting short-term prognosis underexplored. Therefore, this study aimed to investigate the impact of HRR on the short-term (7-day) prognosis of patients after cardiac arrest.

Methods:This study retrospectively analyzed data from adult in-hospital cardiac arrest patients who underwent successful cardiopulmonary resuscitation and achieved the return of spontaneous circulation at Yantai Yuhuangding Hospital between 2023 and 2025. The first available laboratory data after return of spontaneous circulation were collected. Significant variables affecting 7-day mortality were identified using univariate and multivariable Cox regression analyses. Additionally, Kaplan–Meier curves were used to further explore the impact of the HRR on the short-term mortality of the patients. Finally, a nomogram model incorporating HRR was developed for clinical prediction of in-hospital mortality risk.

Results:A total of 216 patients who met the inclusion and exclusion criteria were enrolled in this study. The multivariate Cox regression analysis revealed that HRR (hazard ratio: 0.887; 95% confidence interval: 0.845–0.931) and other factors were associated with the short-term mortality of the patients. After adjusting for relevant factors, it was found that Kaplan–Meier curves demonstrated that a decrease in HRR was correlated with an increased short-term mortality rate in the patients (P < 0.05).

Conclusion:The initial postresuscitation HRR (<9.13) level was significantly associated with an increased risk of short-term mortality in cardiac arrest patients.

Background: This study aimed to characterize fatal heat stroke (HS) and develop a risk-prediction model for early identification of high-risk patients.

Methods: Patients with HS were divided into survival and nonsurvival groups based on discharge outcomes. Baseline demographics and laboratory parameters were compared. After univariate logistic regression identified candidate variables (P < 0.05), stepwise multivariate logistic regression was performed to select independent predictors of mortality for the final model. A combined predictive model was constructed and evaluated using the Hosmer–Lemeshow test and area under the receiver operating characteristic curve (AUC). Differences in AUCs between models were compared using DeLong test. The optimal cutoff value was determined using the Youden index. Internal validation of the final model was performed using the bootstrap method with 1000 resamples.

Results: A total of 209 patients with HS were analyzed, including 165 survivors (78.9%). Nonsurvivors were significantly older, had a higher proportion of females, and exhibited elevated respiratory rate, international normalized ratio, hydroxybutyrate dehydrogenase, cardiac troponin I (cTnI), neutrophil-to-lymphocyte ratio, systemic immune-inflammation index (SII), quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA), and Acute Physiology and Chronic Health Evaluation II scores, along with lower lymphocyte percentage (all P < 0.05). Multivariate logistic regression identified age, cTnI, qSOFA, and SII as independent risk factors for mortality. The combined model demonstrated excellent discriminatory power (AUC = 0.955 vs. age = 0.897; qSOFA = 0.789; cTnI = 0.847; SII = 0.596; DeLong P < 0.05), outperforming all individual predictors.

Conclusion: Older age, elevated cTnI, higher qSOFA, and SII scores independently predict mortality in HS patients. The combination of these factors offers superior predictive value.

Trial Registration: Chinese Clinical Trial Registry; www.chictr.org.cn; ChiCTR2400079671.

Background:Endotracheal intubation of critically ill patients is associated with various complications, mainly hypotension. The administration of an intravenous fluid bolus before induction of anesthesia has been used to prevent hypotension during endotracheal intubation in the intensive care unit (ICU). However, some patients still experience hemodynamic instability. Therefore, this study was conducted to compare the effect of a fluid bolus alone and a fluid bolus plus low-dose noradrenaline infusion on cardiovascular collapse among critically ill adults before tracheal intubation.

Methods:The randomized trial enrolled 136 critically ill patients who required endotracheal intubation. Patients were allocated to the intravenous fluid (group A) and the intravenous fluid plus low-dose noradrenaline group (group B). Cardiovascular collapse, hypotension, and other secondary outcomes were recorded.

Results:Vasopressor requirement at 2 minutes postinduction was lower in group B (39.7%) than in group A (44.1%). Cardiac arrest within 1 hour occurred in 2.9% of patients in group A. Death within 1 hour occurred in 2.9% patients of group A and 1.5% of group B. The requirement for renal replacement therapy, duration of vasopressor requirement and inhospital mortality were higher in group B. The duration of ICU stay and the duration of ventilator requirement were higher in group A. All these differences were statistically insignificant except for the total duration of hospital stay, which was longer in group A than in group B (P = 0.036).

Conclusion:Among critically ill patients undergoing tracheal intubation, the administration of intravenous fluid bolus plus low-dose noradrenaline, compared with a fluid bolus alone, did not significantly reduce the incidence of cardiovascular collapse.