Miroz JP, Ben-Hamouda N, Bernini A, et al. - Given that significant morbidity and mortality associated with venoarterial extracorporeal membrane oxygenation therapy (VA-ECMO) following refractory cardiogenic shock or cardiac arrest has been reported, and it is important to predict the outcome early in this setting, but data on neuroprognostication are limited, so, researchers assessed the prognostic significance of clinical neurologic examination, adopting an automated device for the quantitative measurement of pupillary light reactivity. They analyzed the overall 100 consecutive patients, including 51 cases of refractory cardiogenic shock and 49 of refractory cardiac arrest. Findings revealed the excellent ability of quantitative Neurological Pupil index (NPi) alone to predict a poor outcome from day 1 following VA-ECMO insertion, with no false positives. Increased sensitivity of outcome prediction was yielded by combining NPi and 12-h PREDICT-VA ECMO score, and by doing so, 100% specificity remained maintained.