TY - JOUR
T1 - Oxygen targets and 6-month outcome after out of hospital cardiac arrest
T2 - a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial
AU - Robba, Chiara
AU - Lilja, Gisela
AU - Friberg, Hans
AU - Chew, Michelle S.
AU - Unden, Johan
AU - Dankiewicz, Josef
AU - Nielsen, Niklas
AU - Ebner, Florian
AU - Pelosi, Paolo
AU - TTM2 Trial collaborators
A2 - Cronberg, Tobias
A2 - Erlinge, David
A2 - Levin, Helena
A2 - Nordberg, Per
A2 - Ullén, Susann
A2 - Palmér, Karolina
A2 - Karlsson, Ulla Britt
A2 - Heissler, Simon
A2 - Ceric, Ameldina
A2 - Haxhija, Zana
A2 - Düring, Joachim
A2 - Bergström, Mattias
A2 - Bohm, Mattias
A2 - Didriksson, Ingrid
A2 - Frid, Petrea
A2 - Heimburg, Katarina
A2 - Lundberg, Oscar
A2 - Hau, Stefan Olsson
A2 - Schmidbauer, Simon
A2 - Borgquist, Ola
A2 - Bjärnroos, Anna
A2 - Blennow Nordström, Erik
A2 - Dragancea, Irina
A2 - Kander, Thomas
A2 - Lybeck, Anna
A2 - Mattiasson, Gustav
A2 - Rundgren, Malin
A2 - Westhall, Erik
A2 - Annborn, Martin
A2 - Andertun, Sara
A2 - Johnsson, Jesper
A2 - Unden, Johan
A2 - Wijdicks, Eelco F. M.
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022
Y1 - 2022
N2 - Background: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients’ outcome. Methods: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). Conclusions: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration: clinicaltrials.gov NCT02908308, Registered September 20, 2016.
AB - Background: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients’ outcome. Methods: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). Conclusions: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration: clinicaltrials.gov NCT02908308, Registered September 20, 2016.
KW - Cardiac arrest
KW - Hyperoxemia
KW - Hypoxemia
KW - Mortality
KW - Neurological outcome
U2 - 10.1186/s13054-022-04186-8
DO - 10.1186/s13054-022-04186-8
M3 - Article
C2 - 36271410
AN - SCOPUS:85140287744
SN - 1364-8535
VL - 26
SP - 1
EP - 13
JO - Critical Care
JF - Critical Care
M1 - 323
ER -