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Multicenter Study
. 2017 Nov:120:113-118.
doi: 10.1016/j.resuscitation.2017.08.244. Epub 2017 Sep 21.

Post-resuscitation arterial oxygen and carbon dioxide and outcomes after out-of-hospital cardiac arrest

Henry E Wang  1 , David K Prince  2 , Ian R Drennan  3 , Brian Grunau  4 , David J Carlbom  5 , Nicholas Johnson  6 , Matthew Hansen  7 , Jonathan Elmer  8 , Jim Christenson  4 , Peter Kudenchuk  9 , Tom Aufderheide  10 , Myron Weisfeldt  11 , Ahamed Idris  12 , Stephen Trzeciak  13 , Michael Kurz  14 , Jon C Rittenberger  8 , Denise Griffiths  7 , Jamie Jasti  10 , Susanne May  2 ; Resuscitation Outcomes Consortium (ROC) Investigators
Affiliations
Multicenter Study

Post-resuscitation arterial oxygen and carbon dioxide and outcomes after out-of-hospital cardiac arrest

Henry E Wang et al. Resuscitation. 2017 Nov.

Abstract

Objective: To determine if arterial oxygen and carbon dioxide abnormalities in the first 24h after return of spontaneous circulation (ROSC) are associated with increased mortality in adult out-of-hospital cardiac arrest (OHCA).

Methods: We used data from the Resuscitation Outcomes Consortium (ROC), including adult OHCA with sustained ROSC ≥1h after Emergency Department arrival and at least one arterial blood gas (ABG) measurement. Among ABGs measured during the first 24h of hospitalization, we identified the presence of hyperoxemia (PaO2≥300mmHg), hypoxemia (PaO2<60mmHg), hypercarbia (PaCO2>50mmHg) and hypocarbia (PaCO2<30mmHg). We evaluated the associations between oxygen and carbon dioxide abnormalities and hospital mortality, adjusting for confounders.

Results: Among 9186 OHCA included in the analysis, hospital mortality was 67.3%. Hyperoxemia, hypoxemia, hypercarbia, and hypocarbia occurred in 26.5%, 19.0%, 51.0% and 30.6%, respectively. Initial hyperoxemia only was not associated with hospital mortality (adjusted OR 1.10; 95% CI: 0.97-1.26). However, final and any hyperoxemia (1.25; 1.11-1.41) were associated with increased hospital mortality. Initial (1.58; 1.30-1.92), final (3.06; 2.42-3.86) and any (1.76; 1.54-2.02) hypoxemia (PaO2<60mmHg) were associated with increased hospital mortality. Initial (1.89; 1.70-2.10); final (2.57; 2.18-3.04) and any (1.85; 1.67-2.05) hypercarbia (PaCO2>50mmHg) were associated with increased hospital mortality. Initial (1.13; 0.90-1.41), final (1.19; 1.04-1.37) and any (1.01; 0.91-1.12) hypocarbia (PaCO2<30mmHg) were not associated with hospital mortality.

Conclusions: In the first 24h after ROSC, abnormal post-arrest oxygen and carbon dioxide tensions are associated with increased out of-hospital cardiac arrest mortality.

Keywords: Cardiopulmonary arrest; Hypercarbia; Hyperoxemia; Hypocarbia; Hypoxemia; Post-arrest care.

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Conflict of interest statement

Conflicts of interest

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Study population. Analysis included OHCA = Out-of-hospital cardiac arrest. ROSC = Return of spontaneous circulation. ED = Emergency Department. ABG = Arterial blood gas.
Fig. 2
Fig. 2
Arterial partial pressure of oxygen (left panel) and carbon dioxide (right panel) vs. time of arterial blood gas sample. Includes 35,576 ABGs among 9176 patients with surviving at least 1 h in the Emergency Department. ABG = arterial blood gas. Hatched line depicts PaO2 = 300 mmHg.
Fig. 3
Fig. 3
Adjusted associations between oxygen and carbon dioxide abnormalities and death. Whiskers depict results of 12 separate multivariable models, each with an individual oxygen or carbon dioxide abnormality as the key exposure. Each of the 12 models adjusted for age, sex, witnessed arrest, bystander CPR, initial ECG rhythm and ROC clinical site..
See this image and copyright information in PMC

Comment in

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