Hyo Jin Bang, Chun Song Youn, Min Chul Kim, Yongwhan Lim, Young-Jae Cho, Bitna Chu, June-Sung Kim, Youn-Jung Kim, Byoung-Gil Yoon, Jin Park, Min-Ju Kang, Kyung Woon Jeung, Soo Hyun Kim, Je Hyeok Oh, Taegyun Kim, Sang Hoon Oh, Yong Soo Kim, Changshin Kang, Dong Hun Lee, Jin Hong Min, Hyo Joon Kim, Do Kyun Kim, Tae-Youn Kim, Youdong Sohn, Gyuhong Shim, Young Hwa Jung, Yunhee Oh, Mi Jin Lee, Jisook Lee, Chang Hee Lee, Youngbin Jang, Yong Soo Jang, Gyu Chong Cho, Kyoung-Chul Cha, Ju Sun Heo, Sung Oh Hwang, Sung Phil Chung
Clin Exp Emerg Med 2026;13(Suppl 1):S75-S100. Published online May 31, 2026
This guideline summarizes evidence-based post–cardiac arrest care following the return of spontaneous circulation (ROSC) in adults, incorporating updates from the 2025 Korean Guidelines for Cardiopulmonary Resuscitation and contemporary international evidence. Recommendations were informed by recent randomized controlled trials and systematic reviews, with an emphasis on patient-centered outcomes and practical clinical applications. After ROSC, early evaluation should focus on identifying reversible causes. A 12-lead electrocardiogram should be obtained promptly, with echocardiography and whole-body computed tomography performed when clinically indicated to assess cardiac function and detect noncardiac or occult etiologies. Respiratory management aims to minimize secondary brain injury by preventing hypoxemia and hyperoxemia. High inspired oxygen concentrations may be used initially, followed by titration to an appropriate oxygen saturation level once reliable measurements are available, and ventilation should target normocapnia. Hemodynamic management prioritizes adequate organ perfusion and prompt treatment of shock, including active correction of hypotension. Routine immediate coronary angiography is not recommended in patients without ST-segment elevation. However, urgent angiography is indicated in those with ST-segment elevation, cardiogenic shock, or a high likelihood of ongoing myocardial ischemia. In comatose survivors, temperature control is essential. The selected target temperature should be maintained for at least 24 hours, with active fever prevention for 36 to 72 hours. Additional intensive care unit management includes glucose control and seizure monitoring. Routine prophylactic antibiotics or anticonvulsants are not recommended. Neuroprognostication should use a multimodal approach after confounders, such as sedation and temperature management, are addressed, integrating clinical examination, electrophysiology, biomarkers, and neuroimaging to support individualized decision-making.
Objective The National Early Warning Score (NEWS), based on the patients’ vital signs, detects clinical deterioration in critically ill patients and is used to reduce the incidence of in-hospital cardiac arrest. However, although mortality prediction based on vital signs may be difficult in older patients, the effectiveness of the NEWS has not yet been evaluated in this population. This study aimed to test the hypothesis that an elevated NEWS at admission increases the mortality risk in older patients admitted to the emergency department (ED).
Methods We conducted a single-center retrospective study, including patients admitted to the ED between November 2016 and February 2017. We included patients aged >65 years who were admitted to the ED for any medical problem. The NEWS was calculated at the time of ED admission. The primary outcome was in-hospital mortality.
Results In total, 3,169 patients were included in this study. Median age was 75 years (interquartile range [IQR], 70 to 80 years), and 1,557 (49.1%) patients were male. The in-hospital mortality rate was 5.1% (161 patients). Median NEWS was higher in non-survivors than in survivors (5 [IQR, 3–8] vs. 1 [IQR, 0–3], P<0.001). Multivariate logistic analysis showed that the NEWS was associated with in-hospital mortality, after adjusting for other confounders. The area under the curve of the NEWS for predicting in-hospital mortality was 0.820 (95% confidence interval, 0.806 to 0.833).
Conclusion Our results show that the NEWS at admission is associated with in-hospital mortality among patients aged >65 years.
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Objective The objective of this study was to test the hypothesis that hemoglobin concentration after return of spontaneous circulation (ROSC) is associated with neurologic outcome after cardiac arrest in patients treated with targeted temperature management.
Methods We studied consecutive adult patients with out-of-hospital cardiac arrest treated with targeted temperature management between January 2009 and December 2015. We quantified the association between post ROSC hemoglobin concentrations and good neurologic outcome (defined as Cerebral Performance Category of 1 and 2) at hospital discharge using multivariate logistic regression analysis.
Results A total of 246 subjects were ultimately included in this study. The mean age was 54 years (standard deviation, 17); 168 (68%) subjects were male. Eighty-seven (35%) subjects had a good neurologic outcome at hospital discharge. Hemoglobin concentrations were higher in the good outcome group than in the poor outcome group (14.4±2.0 vs. 12.8±2.5 g/dL, P<0.001). Multivariate logistic regression analysis showed that hemoglobin concentrations were associated with good neurologic outcome at hospital discharge after adjusting for other confounding factors (adjusted odds ratio, 1.186; 95% confidence interval, 1.008 to 1.395).
Conclusion These results show that hemoglobin concentrations after ROSC are associated with neurologic outcome at hospital discharge. Future research to examine the association between hemoglobin levels and neurologic outcome after cardiac arrest is warranted.
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Objective The objective of this study was to test the hypothesis that an elevated high-sensitivity C-reactive protein (hs-CRP)/albumin ratio at admission increases the risk of mortality in older patients admitted to the hospital via the emergency department (ED).
Methods We performed a retrospective analysis of patients admitted to the ED with any medical problem between May 2013 and October 2013 who were older than 65 years. The hs-CRP and albumin levels were measured at the time of admission to the ED. The primary outcome was all-cause in-hospital mortality. Multivariate logistic analysis was performed.
Results A total of 811 patients were finally included in this study. The mean age was 76±7 years, and 438 subjects (54%) were male. The in-hospital mortality rate was 9.0% (73 patients). The hs-CRP/albumin ratio was higher in nonsurvivors than in survivors (34.2±37.6 vs. 16.2±25.5, P<0.001). Multivariate logistic analysis showed that the hs-CRP/albumin ratio was associated with all-cause in-hospital mortality after adjusting for other confounding factors (odds ratio, 1.011; 95% confidence interval [CI], 1.003 to 1.020). The prognostic value of the hs-CRP/albumin ratio for predicting mortality (area under the curve, 0.728; 95% CI, 0.696 to 0.758) was greater than that of hs-CRP alone (area under the curve, 0.706; 95% CI, 0.674 to 0.738; P<0.001).
Conclusion The hs-CRP/albumin ratio at admission to the ED is associated with all-cause in-hospital mortality among patients older than 65 years. The hs-CRP/albumin ratio may serve as a surrogate marker of disease severity.
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Predicting Poor Outcome of COVID-19 Patients on the Day of Admission with the COVID-19 Score Luke Tseng, Erin Hittesdorf, Mitchell F. Berman, Desmond A. Jordan, Nina Yoh, Katerina Elisman, Katherine A. Eiseman, Yuqi Miao, Shuang Wang, Gebhard Wagener, Samuel A. Tisherman Critical Care Research and Practice.2021; 2021: 1. CrossRef
Determinants of prognosis in geriatric patients followed in respiratory ICU; either infection or malnutrition Guler Eraslan Doganay, Mustafa Ozgur Cirik Medicine.2021; 100(36): e27159. CrossRef
Novel Systemic Inflammation Markers to Predict COVID-19 Prognosis Amirali Karimi, Parnian Shobeiri, Arutha Kulasinghe, Nima Rezaei Frontiers in Immunology.2021;[Epub] CrossRef
Abnormal routine blood tests as predictors of mortality in acutely admitted patients Rasmus Roenhoej (Rønhøj), Rasmus B. Hasselbalch, Martin Schultz, Mia Pries-Heje, Louis L. Plesner, Lisbet Ravn, Morten Lind, Birgitte N. Jensen, Thomas Hoei-Hansen (Høi-Hansen), Nicholas Carlson, Christian Torp-Pedersen, Lars S. Rasmussen, Line J.H. Rasmu Clinical Biochemistry.2020; 77: 14. CrossRef
C-reactive protein/albumin ratio designates advanced heart failure among outpatients with heart failure Oguzhan Yucel, Hakan Günes, Murat Kerkütlüoglu, MehmetBirhan Yılmaz International Journal of the Cardiovascular Academy.2020; 6(2): 51. CrossRef
Serum C-reactive protein to albumin ratio and mortality associated with peritoneal dialysis Siyi Liu, Panlin Qiu, Laimin Luo, Lei Jiang, Yanbing Chen, Caixia Yan, Xiaojiang Zhan Renal Failure.2020; 42(1): 600. CrossRef
Differential diagnostic factors of type 1 and type 2 myocardial infarction in patients with elevated cardiac troponin levels Youngho Seo, Jinhui Paik, Seunglyul Shin, Ahjin Kim, Soo Kang Clinical and Experimental Emergency Medicine.2020; 7(3): 213. CrossRef
Serum Albumin and C-Reactive Protein as Predictors of Adverse Outcomes in Critically Ill Children: A Prospective Observational Pilot Study Neha Bhandarkar, Sushma Save, Sandeep B. Bavdekar, Pankhuri Sisodia, Saumil Desai The Indian Journal of Pediatrics.2019; 86(8): 758. CrossRef
Risk assessment models for potential use in the emergency department have lower predictive ability in older patients compared to the middle-aged for short-term mortality – a retrospective cohort study Martin Schultz, Line Jee Hartmann Rasmussen, Nicolas Carlson, Rasmus Bo Hasselbalch, Birgitte Nybo Jensen, Lotte Usinger, Jesper Eugen-Olsen, Christian Torp-Pedersen, Lars Simon Rasmussen, Kasper Karmark Iversen BMC Geriatrics.2019;[Epub] CrossRef
Predictive utility of the C-reactive protein to albumin ratio in early allograft dysfunction in living donor liver transplantation: A retrospective observational cohort study Jaesik Park, Soo Jin Lim, Ho Joong Choi, Sang Hyun Hong, Chul Soo Park, Jong Ho Choi, Min Suk Chae, Yun-Wen Zheng PLOS ONE.2019; 14(12): e0226369. CrossRef
The High-Sensitivity C-Reactive Protein/Albumin Ratio Predicts Long-Term Oncologic Outcomes after Curative Resection for Hepatocellular Carcinoma Tak Oh, Young-Rok Choi, Jai Cho, Yoo-Suk Yoon, Ho-Seong Han, In Park, Jung-Hee Ryu Journal of Clinical Medicine.2018; 7(6): 139. CrossRef
Use of the prognostic biomarker suPAR in the emergency department improves risk stratification but has no effect on mortality: a cluster-randomized clinical trial (TRIAGE III) Martin Schultz, Line Jee Hartmann Rasmussen, Malene H. Andersen, Jakob S. Stefansson, Alexander C. Falkentoft, Morten Alstrup, Andreas Sandø, Sarah L. K. Holle, Jeppe Meyer, Peter B. S. Törnkvist, Thomas Høi-Hansen, Erik Kjøller, Birgitte Nybo Jensen, Mor Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2018;[Epub] CrossRef
The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients Ji Eun Park, Kyung Soo Chung, Joo Han Song, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Moo Suk Park, Young Sam Kim, Joon Chang, Ah Young Leem Journal of Clinical Medicine.2018; 7(10): 333. CrossRef
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