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.
Young-Min Kim, Chan Woong Kim, Kyung Hye Park, Hyo Joon Kim, Kyung Jun Song, Sung Phil Chung, Dong Ryul Ko, Tae Han Kim, on behalf of KSEM Quality Improvement in Residency Training Committee
Clin Exp Emerg Med 2026;13(2):227-235. Published online April 8, 2026
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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