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. 2018 May 15;137(20):2114-2124.
doi: 10.1161/CIRCULATIONAHA.117.032054. Epub 2018 Feb 1.

Association Between Early Hyperoxia Exposure After Resuscitation From Cardiac Arrest and Neurological Disability: Prospective Multicenter Protocol-Directed Cohort Study

Brian W Roberts  1 , J Hope Kilgannon  1 , Benton R Hunter  2 , Michael A Puskarich  3 , Lisa Pierce  4 , Michael Donnino  5 , Marion Leary  6 , Jeffrey A Kline  2 , Alan E Jones  3 , Nathan I Shapiro  5 , Benjamin S Abella  6 , Stephen Trzeciak  7   4
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Association Between Early Hyperoxia Exposure After Resuscitation From Cardiac Arrest and Neurological Disability: Prospective Multicenter Protocol-Directed Cohort Study

Brian W Roberts et al. Circulation. .

Abstract

Background: Studies examining the association between hyperoxia exposure after resuscitation from cardiac arrest and clinical outcomes have reported conflicting results. Our objective was to test the hypothesis that early postresuscitation hyperoxia is associated with poor neurological outcome.

Methods: This was a multicenter prospective cohort study. We included adult patients with cardiac arrest who were mechanically ventilated and received targeted temperature management after return of spontaneous circulation. We excluded patients with cardiac arrest caused by trauma or sepsis. Per protocol, partial pressure of arterial oxygen (Pao2) was measured at 1 and 6 hours after return of spontaneous circulation. Hyperoxia was defined as a Pao2 >300 mm Hg during the initial 6 hours after return of spontaneous circulation. The primary outcome was poor neurological function at hospital discharge, defined as a modified Rankin Scale score >3. Multivariable generalized linear regression with a log link was used to test the association between Pao2 and poor neurological outcome. To assess whether there was an association between other supranormal Pao2 levels and poor neurological outcome, we used other Pao2 cut points to define hyperoxia (ie, 100, 150, 200, 250, 350, 400 mm Hg).

Results: Of the 280 patients included, 105 (38%) had exposure to hyperoxia. Poor neurological function at hospital discharge occurred in 70% of patients in the entire cohort and in 77% versus 65% among patients with versus without exposure to hyperoxia respectively (absolute risk difference, 12%; 95% confidence interval, 1-23). Hyperoxia was independently associated with poor neurological function (relative risk, 1.23; 95% confidence interval, 1.11-1.35). On multivariable analysis, a 1-hour-longer duration of hyperoxia exposure was associated with a 3% increase in risk of poor neurological outcome (relative risk, 1.03; 95% confidence interval, 1.02-1.05). We found that the association with poor neurological outcome began at ≥300 mm Hg.

Conclusions: Early hyperoxia exposure after resuscitation from cardiac arrest was independently associated with poor neurological function at hospital discharge.

Keywords: brain injuries; heart arrest; hyperoxia; nervous system.

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Conflict of interest statement

Disclosures: None of the authors have potential financial conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Study flow diagram ROSC, return of spontaneous circulation
Figure 2
Figure 2
Modified Rankin Scale at hospital discharge stratified by no hyperoxia (gray columns) and hyperoxia (black columns). mRS: 0, no symptoms; 1, no significant disability; 2, slight disability; 3, moderate disability; 4, moderate severe disability; 5, severe disability; 6, death
Figure 3
Figure 3
Adjusted relative risks (squares) with 95% confidence intervals (horizontal lines) for poor neurological outcome [defined as modified Rankin Scale (mRS) > 3] across ascending cut points to define hyperoxia. *Relative risks were calculated using multivariable linear regression analysis (with a log link) adjusting for age, initial cardiac rhythm, metabolic acidosis, arterial hypotension, pre-arrest comorbidities, and prolonged duration of cardiopulmonary resuscitation.
Cut pointNo Hyperoxia; n (Proportion with mRS > 3)Hyperoxia; n (Proportion with mRS >3)
10040 (60%)240 (71%)
15077 (64%)203 (72%)
200114 (67%)166 (72%)
250139 (66%)141 (73%)
300175 (65%)105 (77%)
350199 (65%)81 (80%)
400216 (67%)64 (78%)
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References

    1. Negovsky VA, Gurvitch AM. Post-resuscitation disease–a new nosological entity. Its reality and significance. Resuscitation. 1995;30:23–27. - PubMed
    1. Nolan JP, Neumar RW, Adrie C, Aibiki M, Berg RA, Bbttiger BW, Callaway C, Clark RS, Geocadin RG, Jauch EC, Kern KB, Laurent I, Longstreth WT, Merchant RM, Morley P, Morrison LJ, Nadkarni V, Peberdy MA, Rivers EP, Rodriguez-Nunez A, Sellke FW, Spaulding C, Sunde K, Vanden Hoek T, International Liaison Committee on R, Emergency Cardiovascular Care Committee AHA, Council on Cardiovascular S, Anesthesia, Council on Cardiopulmonary P, Critical C, Council on Clinical C, Council on S Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication: a scientific statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke (Part II) Int Emerg Nurs. 2010;18:8–28. - PubMed
    1. Trzeciak S, Jones AE, Kilgannon JH, Milcarek B, Hunter K, Shapiro NI, Hollenberg SM, Dellinger P, Parrillo JE. Significance of arterial hypotension after resuscitation from cardiac arrest. Crit Care Med. 2009;37:2895–2903. - PubMed
    1. Kong MH, Fonarow GC, Peterson ED, Curtis AB, Hernandez AF, Sanders GD, Thomas KL, Hayes DL, Al-Khatib SM. Systematic review of the incidence of sudden cardiac death in the United States. J Am Coll Cardiol. 2011;57:794–801. - PMC - PubMed
    1. Becker LB. New concepts in reactive oxygen species and cardiovascular reperfusion physiology. Cardiovasc Res. 2004;61:461–470. - PubMed

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