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Randomized Controlled Trial
. 2018 Dec;44(12):2112-2121.
doi: 10.1007/s00134-018-5453-9. Epub 2018 Nov 14.

Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial

Pekka Jakkula  1 , Matti Reinikainen  2 , Johanna Hästbacka  3 , Pekka Loisa  4 , Marjaana Tiainen  5 , Ville Pettilä  3 , Jussi Toppila  6 , Marika Lähde  7 , Minna Bäcklund  3 , Marjatta Okkonen  3 , Stepani Bendel  8 , Thomas Birkelund  9 , Anni Pulkkinen  10 , Jonna Heinonen  3 , Tuukka Tikka  3 , Markus B Skrifvars  3   11 ; COMACARE study group
Affiliations
Randomized Controlled Trial

Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial

Pekka Jakkula et al. Intensive Care Med. 2018 Dec.

Abstract

Purpose: We assessed the effects of targeting low-normal or high-normal arterial carbon dioxide tension (PaCO2) and normoxia or moderate hyperoxia after out-of-hospital cardiac arrest (OHCA) on markers of cerebral and cardiac injury.

Methods: Using a 23 factorial design, we randomly assigned 123 patients resuscitated from OHCA to low-normal (4.5-4.7 kPa) or high-normal (5.8-6.0 kPa) PaCO2 and to normoxia (arterial oxygen tension [PaO2] 10-15 kPa) or moderate hyperoxia (PaO2 20-25 kPa) and to low-normal or high-normal mean arterial pressure during the first 36 h in the intensive care unit. Here we report the results of the low-normal vs. high-normal PaCO2 and normoxia vs. moderate hyperoxia comparisons. The primary endpoint was the serum concentration of neuron-specific enolase (NSE) 48 h after cardiac arrest. Secondary endpoints included S100B protein and cardiac troponin concentrations, continuous electroencephalography (EEG) and near-infrared spectroscopy (NIRS) results and neurologic outcome at 6 months.

Results: In total 120 patients were included in the analyses. There was a clear separation in PaCO2 (p < 0.001) and PaO2 (p < 0.001) between the groups. The median (interquartile range) NSE concentration at 48 h was 18.8 µg/l (13.9-28.3 µg/l) in the low-normal PaCO2 group and 22.5 µg/l (14.2-34.9 µg/l) in the high-normal PaCO2 group, p = 0.400; and 22.3 µg/l (14.8-27.8 µg/l) in the normoxia group and 20.6 µg/l (14.2-34.9 µg/l) in the moderate hyperoxia group, p = 0.594). High-normal PaCO2 and moderate hyperoxia increased NIRS values. There were no differences in other secondary outcomes.

Conclusions: Both high-normal PaCO2 and moderate hyperoxia increased NIRS values, but the NSE concentration was unaffected.

Registration: ClinicalTrials.gov, NCT02698917. Registered on January 26, 2016.

Keywords: Carbon dioxide; Cardiac arrest; Hypoxic ischemic encephalopathy; Intensive care; Mechanical ventilation; Neuron-specific enolase (NSE); Oxygen.

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Figures

Fig. 1
Fig. 1
Median (interquartile range) a PaCO2 during the intervention in the low-normal and high-normal PaCO2 groups. b PaO2 during the intervention in the normoxia and moderate hyperoxia groups
Fig. 2
Fig. 2
Baseline, 24 h, 48 h and 72 h median (interquartile range) serum neuron-specific enolase (NSE) concentrations for patients allocated to targeting a low-normal and high-normal PaCO2, b normoxia and moderate hyperoxia
Fig. 3
Fig. 3
Baseline, 24 h, 48 h and 72 h median (interquartile range) serum S100B concentrations for patients allocated to targeting a low-normal and high-normal PaCO2, b normoxia and moderate hyperoxia
Fig. 4
Fig. 4
Baseline, 24 h, 48 h and 72 h median (interquartile range) plasma cardiac troponin (TnT) concentrations for patients allocated to targeting a low-normal and high-normal PaCO2, b normoxia and moderate hyperoxia
Fig. 5
Fig. 5
Median (interquartile range) regional cerebral oxygen saturation (rSO2) during the intervention in the a low-normal and high-normal PaCO2 groups. b normoxia and moderate hyperoxia groups
See this image and copyright information in PMC

Comment in

  • NSE concentrations and haemolysis after cardiac arrest.
    Jakkula P, Skrifvars MB, Pettilä V, Hästbacka J, Reinikainen M. Jakkula P, et al. Intensive Care Med. 2019 May;45(5):741-742. doi: 10.1007/s00134-019-05547-8. Epub 2019 Feb 13. Intensive Care Med. 2019. PMID: 30758520 No abstract available.

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