Early and precise neurological prognostication without self-fulfilling prophecy is challenging in post-cardiac arrest syndrome (PCAS), particularly during the targeted temperature management (TTM) period. This study aimed to investigate the feasibility of vasomotor reactivity (VMR) using transcranial Doppler (TCD) to determine whether final outcomes of patients with comatose PCAS are predicted. This study included patients who had out-of-hospital cardiac arrest in a tertiary referral hospital over 4 years. The eligible criteria included age ≥18 years, successful return of spontaneous circulation, TTM application, and bedside TCD examination within 72 h. Baseline demographics and multimodal prognostic parameters, including imaging findings, electrophysiological studies, and TCD-VMR parameters, were assessed. The final outcome parameter was cerebral performance category scale (CPC) at 1 month. Potential determinants were compared between good (CPC 1–2) and poor (CPC 3–5) outcome groups. The good outcome group (n = 41) (vs. poor (n = 117)) showed a higher VMR value (54.4% ± 33.0% vs. 25.1% ± 35.8%, p < 0.001). The addition of VMR to conventional prognostic parameters significantly improved the prediction power of good outcomes. This study suggests that TCD-VMR is a useful tool at the bedside to evaluate outcomes of patients with comatose PCAS during the TTM.

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