ArticleResuscitation plus2026
Nucleated red blood cells as early predictors of poor neurological outcome after extracorporeal cardiopulmonary resuscitation: a retrospective dual-site cohort study of early laboratory markers.
Article in Resuscitation plus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Early neurological prognostication after extracorporeal cardiopulmonary resuscitation (ECPR) remains difficult. Common pre-cannulation markers such as lactate and pH offer limited accuracy for predicting neurological outcome. Nucleated red blood cells (NRBCs) increase under hypoxemia, yet their value as early predictors of adverse neurological outcome after ECPR has not been evaluated. Methods: We performed a retrospective dual-site cohort study of adult patients who underwent ECPR for refractory circulatory arrest at Charité-Universitätsmedizin Berlin (2020-2024). Laboratory parameters obtained within six hours after admission were analyzed regarding their association with poor neurological outcome at discharge, defined as Cerebral Performance Category 3-5 or death before neuroprognostic assessment. Group differences were assessed using Cliff's Δ, and discriminative performance was evaluated by receiver operating characteristic analysis. Poor neurological outcome served as the positive condition, with rule-in (≥90% specificity) and rule-out (≥90% sensitivity) thresholds. Results: Among 197 patients (median age 55 years [IQR 46-61], 86.0% male), 38 (19.3%) had a good outcome and 159 (80.7%) a poor outcome. NRBCs/100 white blood cells (WBCs) showed the strongest association with outcome: patients with poor outcome had higher values (0.37 Conclusions: NRBCs/100 WBCs measured within six hours after admission showed the best discriminatory ability for poor neurological outcome, outperforming lactate, pH, and other routine laboratory markers. NRBCs may represent a promising early indicator requiring prospective validation.
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