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Optimizing smartwatch emergency sirens for high-quality CPR: a call for multimodal guidance integration

Fri, 01 May 2026 00:00:00 GMT

Title: Optimizing smartwatch emergency sirens for high-quality CPR: a call for multimodal guidance integration Authors: You, Jeesang; You, Je Sung

Age-Comorbidity Interactions and Clinical Outcomes in Septic Shock: An Emergency Department-Based Multicenter Cohort Study

Sun, 01 Mar 2026 00:00:00 GMT

Title: Age-Comorbidity Interactions and Clinical Outcomes in Septic Shock: An Emergency Department-Based Multicenter Cohort Study Authors: Maeng, Seung Jin; Park, Jong Eun; Lee, Gun Tak; Hwang, Sung Yeon; Kim, Minha; Heo, Sejin; Lim, Tae Ho; Chung, Sung Phil; Choi, Sung-Hyuk; Shin, Tae Gun Abstract: Background: Sepsis remains a leading cause of mortality worldwide. This study evaluated the independent and combined effects of age and chronic comorbidities on clinical outcomes in patients with septic shock. Methods: We conducted a multicenter retrospective observational study to evaluate the factors associated with 28-day mortality in the Korean Shock Society registry between 2015 and 2023. Adults with suspected infection and refractory hypotension or hypoperfusion within 6 h of emergency department (ED) arrival were included. Patients were grouped by age (<50, 50-74, and >= 75 years) and comorbidity status. Comorbidities encompass major chronic conditions including hypertension, diabetes mellitus, malignancy, history of organ transplant, dementia, nursing home residence, chronic disease of cardiac, lung, liver, and kidney. The primary outcome was 28-day mortality. Multivariable logistic regression analysis was used. Results: Among 8787 patients (median age 70.2 years), the 28-day mortality rate was 22.9% (n = 2018). Elderly patients with comorbidities had the highest mortality (27.5%). Additionally, patients aged over 50 with at least one comorbidity accounted for 18% of the total cohort (n = 1605) but accounted for nearly 80% of all 28-day deaths. Although younger patients without comorbidities represented a small subgroup, their mortality was not negligible (7.3%) and was substantially higher with comorbidities (22.2%). Compared with patients <50 years, adjusted odds ratios (aORs) of 28-day mortality were 1.81 (95% CI, 1.08-3.03) for 50-74 years and 3.21 (95% CI, 1.92-5.37) for >= 75. The presence of any comorbidities was independently associated with higher odds of 28-day mortality compared with no comorbidity (aOR 2.67; 95% CI, 1.57-4.54). A significant interaction between age and comorbidity status (p for interaction = 0.008) suggested that the age-related gradient in mortality differed depending on comorbidity burden. Conclusions: Age and comorbidities were both significantly associated with septic shock mortality, and their significant interaction demonstrates effect modification, indicating that the prognostic impact of comorbidities differs by age group and that age-related mortality gradients are influenced by comorbidity burden.

Association between early red blood cell transfusion after return of spontaneous circulation and clinical outcomes in cardiac arrest patients

Sun, 01 Mar 2026 00:00:00 GMT

Title: Association between early red blood cell transfusion after return of spontaneous circulation and clinical outcomes in cardiac arrest patients Authors: Lee, Chae Hun; Choi, Ju Hwan; Kim, Sinyoung; Park, Incheol; Chung, Hyun Soo; Kwon, Soon Sung; Myung, Jinwoo Abstract: Red blood cell (RBC) transfusion is frequently administered to patients after cardiac arrest; however, its association with patient outcomes has not been well established. This study investigated the association between early RBC transfusion after the return of spontaneous circulation (ROSC) and patient outcomes in adults with cardiac arrest. We analyzed data from 586 adult patients who achieved ROSC at two university-affiliated hospitals in Korea between August 2014 and December 2023. Early transfusion was defined as RBC transfusion administered within 24 h after ROSC. Overlap propensity score weighting was used to adjust for confounding, and weighted analysis was performed to assess associations between early transfusion and patient outcomes. Within 24 h after ROSC, 79 patients (13.5%) received RBC transfusions. Early RBC transfusion was not significantly associated with 30-day mortality (adjusted hazard ratio [aHR] 0.97, 95% confidence interval [CI] 0.65-1.47), 90-day mortality (aHR 0.95, 95% CI 0.64-1.42), in-hospital mortality (adjusted odds ratio [aOR] 0.99, 95% CI 0.91-1.07), or neurologic outcome (aOR 0.97, 95% CI 0.92-1.03). Consistent findings were observed when early transfusion was defined as occurring within 48 or 72 h after ROSC. The number of RBC units transfused was also not associated with patient outcomes. Early RBC transfusion after ROSC was not associated with survival or neurologic outcomes in patients with cardiac arrest.

Etiology-specific prognostic value of ultra-early diffusion-weighted MRI after out-of-hospital cardiac arrest: a multicenter cohort study

Sun, 01 Mar 2026 00:00:00 GMT

Title: Etiology-specific prognostic value of ultra-early diffusion-weighted MRI after out-of-hospital cardiac arrest: a multicenter cohort study Authors: Min, Jin Hong; You, Yeonho; Park, Jung Soo; Kang, Changshin; Ryu, Hyun Shik; Jeong, Wonjoon; Oh, Se Kwang; Jeon, So Young; Lee, In Ho; Jeong, Hye Seon; Chung, Sung Phil; Beekman, Rachel; Lee, Byung Kook; Lee, Dong Hun Abstract: Background Diffusion-weighted magnetic resonance imaging (DW-MRI) within 0-6 h after return of spontaneous circulation can detect hypoxic-ischemic brain injury following out-of-hospital cardiac arrest (OHCA). Whether ultra-early findings differ by arrest etiology and how they should guide prognostication remains uncertain. Methods We conducted a multicenter retrospective cohort study of OHCA survivors who underwent ultra-early DW-MRI (0-6 h); a subset had follow-up scans (72-96 h). Etiology was classified as cardiac or respiratory. We assessed the prognostic performance of qualitative ultra-early high-signal-intensity (HSI) and quantitative ADC-R(650) (% brain voxels with ADC <= 650 & times; 10(-)(6) mm & sup2;/s) using receiver operating characteristic analysis to estimate the area under the curve (AUC) and sensitivity at 100% specificity. Qualitative HSI was based on routine clinical readings, with readers blinded to clinical outcomes and other clinical information. The primary outcome was poor neurological outcome at 6 months (CPC 3-5). Results Among 176 patients (77 cardiac, 99 respiratory), 94 (53.4%) had poor outcomes. Ultra-early HSI occurred exclusively in patients with poor outcomes, yielding 100% specificity in both etiologies. At 100% specificity, sensitivity was significantly lower for respiratory etiology (52% vs. 86%; P = 0.006). Ultra-early HSI predicted poor outcome (AUC 0.80), with higher discrimination in the cardiac etiology subgroup (0.93 vs. 0.76; P < 0.001). In contrast, ultra-early ADC-R(650) showed modest prognostic value (AUC 0.77), but with similar discrimination between cardiac and respiratory etiology subgroups (0.80 vs. 0.77; P = 0.71). In the follow-up subset (n = 150), HSI demonstrated high discrimination for poor outcome (AUC 0.93) with no difference in AUC between cardiac and respiratory etiologies (0.96 vs. 0.95; P = 0.57). At this later time point, ADC-R(650) demonstrated high prognostic performance (AUC 0.91), with comparable results across etiologies (0.89 vs. 0.93; P = 0.47). Conclusions HSI on ultra-early DW-MRI is specific for poor outcome after OHCA, but sensitivity is lower in respiratory etiology. DW-MRI at 72-96 h provides prognostic performance independent of etiology. Following OHCA, ultra-early HSI may help phenotype patients, particularly those with cardiac etiology, supporting an etiology-aware staged approach to DW-MRI-based prognostication. Further validation is warranted to explain delayed diffusion restriction in respiratory etiology.