Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality (original) (raw)
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2021
BackgroundHyperoxia has been associated with adverse outcomes in post cardiac arrest (CA) patients. However, little data are available from mixed cohorts, where extracorporeal membrane oxygenation cardiopulmonary resuscitation (ECPR) and conventional CPR (CCPR) were utilised. The independence of effect of hyperoxia in this setting is not clear. Study-objective was to examine the association between hyperoxia and 30-day mortality in a mixed cohort of ECPR and CCPR patients.Methods and designThis was a retrospective cohort study of CA patients admitted to a tertiary level cardiac arrest centre in Australia from 1st January 2013 to 31st August 2018. Mean arterial oxygen levels (PaO2) and episodes of extreme hyperoxia (PaO2 ≥ 300mmHg) were analysed over the first 8 days. The primary outcome was 30-day mortality.ResultsA total of 169 post CA patients were assessed over a 6.5-year time period: 79 patients undergoing ECPR vs 90 patients undergoing CCPR. The mean age of the cohort was 54 (±...
Hyperoxia and cardiopulmonary resuscitation outcome: where is the data?
Critical Care and Shock
Aims of this study The purpose of this multicenter study was to examine whether delivery of excessive oxygen concentrations (hyperoxia) in the post-resuscitative period to victims of in-and out-of-hospital sudden cardiac death (SCD) with return of spontaneous circulation (ROSC) increased mortality. Methods
JAMA, 2010
S UDDEN CARDIAC ARREST IS THE most common lethal consequence of cardiovascular disease. Even if return of spontaneous circulation (ROSC) from cardiac arrest is achieved, approximately 60% of patients will not survive to hospital discharge. 1,2 The high mortality is attributed to the postcardiac arrest syndrome, which involves global ischemiareperfusion injury, myocardial stunning, and anoxic brain injury. The recent success of therapeutic hypothermia for post-ROSC neuroprotection 4,5 has increased momentum for investigating post-ROSC factors that can improve outcomes.
Resuscitation, 2013
Aim: As recent clinical data suggest a harmful effect of arterial hyperoxia on patients after resuscitation from cardiac arrest (CA), we aimed to investigate this association during cardiopulmonary resuscitation (CPR), the earliest and one of the most crucial phases of recirculation. Methods: We analysed 1015 patients who from 2003 to 2010 underwent out-of-hospital CPR administered by emergency medical services serving 300,000 inhabitants. Inclusion criteria for further analysis were nontraumatic background of CA and patients >18 years of age. One hundred and forty-five arterial blood gas analyses including oxygen partial pressure (paO2) measurement were obtained during CPR. Results: We observed a highly significant increase in hospital admission rates associated with increases in paO2 in steps of 100 mmHg (13.3 kPa). Subsequently, data were clustered according to previously described cutoffs (≤60 mmHg [8 kPa]], 61-300 mmHg [8.1-40 kPa], >300 mmHg [>40 kPa]). Baseline variables (age, sex, initial rhythm, rate of bystander CPR and collapse-to-CPR time) of the three compared groups did not differ significantly. Rates of hospital admission after CA were 18.8%, 50.6% and 83.3%, respectively. In a multivariate analysis, logistic regression revealed significant prognostic value for paO2 and the duration of CPR. Conclusion: This study presents novel human data on the arterial paO2 during CPR in conjunction with the rate of hospital admission. We describe a significantly increased rate of hospital admission associated with increasing paO2. We found that the previously described potentially harmful effects of hyperoxia after return of spontaneous circulation were not reproduced for paO2 measured during CPR. Clinical trial registration: n/a.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2020
Background Exposure to extreme arterial partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) following the return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) is common and may affect neurological outcome but results of previous studies are conflicting. Methods Exploratory study of the International Cardiac Arrest Registry (INTCAR) 2.0 database, including 2162 OHCA patients with ROSC in 22 intensive care units in North America and Europe. We tested the hypothesis that exposure to extreme PaO2 or PaCO2 values within 24 h after OHCA is associated with poor neurological outcome at discharge. Our primary analyses investigated the association between extreme PaO2 and PaCO2 values, defined as hyperoxemia (PaO2 > 40 kPa), hypoxemia (PaO2 6.7 kPa) and hypocapnemia (PaCO2 40 kPa with PaCO2 6.7 kPa and neurological outcome. To define a cut point for the onset of poor neurological outcome, we tested a model with increasing and decreasing PaO2 lev...
Less oxygen for cardiac arrest patients is better
2015
There is no doubt that oxygen is necessary to sustain life. We have been using oxygen since the late 19th century with its use taken for granted. However, administering oxygen above atmospheric concentration should be prescribed as a medication accounting for potential adverse effects. Exposure to high dose of supplemental oxygen has been associated with pulmonary and cardiac toxicity. Moreover, an increase in oxygen radicals was found to be involved in cell death after cerebral ischemia. Cardiac arrest, both in and out of hospital, is a major cause of death worldwide. Brain injury, myocardial dysfunction and multi-organ failure comprise post cardiac arrest syndrome and reactive oxygen species play a central role in initiating and exacerbating the damage. Studies in animal models . of cardiac arrest have found that the administration of 100% oxygen following return of spontaneous circulation (ROSC) may cause neurological harm in comparison to low-dose oxygen. Hyperoxia (PaO2>300 ...