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

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.

journal_name

Resuscitation

journal_title

Resuscitation

authors

Wang HE,Prince DK,Drennan IR,Grunau B,Carlbom DJ,Johnson N,Hansen M,Elmer J,Christenson J,Kudenchuk P,Aufderheide T,Weisfeldt M,Idris A,Trzeciak S,Kurz M,Rittenberger JC,Griffiths D,Jasti J,May S,Resuscitation Outco

doi

10.1016/j.resuscitation.2017.08.244

subject

Has Abstract

pub_date

2017-11-01 00:00:00

pages

113-118

eissn

0300-9572

issn

1873-1570

pii

S0300-9572(17)30598-1

journal_volume

120

pub_type

杂志文章,多中心研究

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