Abstract
IntroductionArterial concentrations of carbon dioxide (PaCO2) and oxygen (PaO2) during admission to the intensive care unit (ICU) may substantially affect organ perfusion and outcome after cardiac arrest. Our aim was to investigate the independent and synergistic effects of both parameters on hospital mortality.MethodsThis was a cohort study using data from mechanically ventilated cardiac arrest patients in the Dutch National Intensive Care Evaluation (NICE) registry between 2007 and 2012. PaCO2 and PaO2 levels from arterial blood gas analyses corresponding to the worst oxygenation in the first 24 h of ICU stay were retrieved for analyses. Logistic regression analyses were performed to assess the relationship between hospital mortality and both categorized groups and a spline-based transformation of the continuous values of PaCO2 and PaO2.ResultsIn total, 5,258 cardiac arrest patients admitted to 82 ICUs in the Netherlands were included. In the first 24 h of ICU admission, hypocapnia was encountered in 22 %, and hypercapnia in 35 % of included cases. Hypoxia and hyperoxia were observed in 8 % and 3 % of the patients, respectively. Both PaCO2 and PaO2 had an independent U-shaped relationship with hospital mortality and after adjustment for confounders, hypocapnia and hypoxia were significant predictors of hospital mortality: OR 1.37 (95 % CI 1.17–1.61) and OR 1.34 (95 % CI 1.08–1.66). A synergistic effect of concurrent derangements of PaCO2 and PaO2 was not observed (P = 0.75).ConclusionsThe effects of aberrant arterial carbon dioxide and arterial oxygen concentrations were independently but not synergistically associated with hospital mortality after cardiac arrest.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1067-6) contains supplementary material, which is available to authorized users.
Highlights
Arterial concentrations of carbon dioxide (PaCO2) and oxygen (PaO2) during admission to the intensive care unit (ICU) may substantially affect organ perfusion and outcome after cardiac arrest
Data from 6,496 out-of-hospital cardiac arrest patients and 82 hospitals were extracted from the National Intensive Care Evaluation (NICE) registry and screened for enrollment (Additional file 1: Figure S1)
In accordance with previous studies, we found that early exposure to both hypo- and hypercapnia is common in ICU patients resuscitated from cardiac arrest [15, 16]
Summary
Arterial concentrations of carbon dioxide (PaCO2) and oxygen (PaO2) during admission to the intensive care unit (ICU) may substantially affect organ perfusion and outcome after cardiac arrest. Our aim was to investigate the independent and synergistic effects of both parameters on hospital mortality. Even after successful resuscitation and return of spontaneous circulation (ROSC), cardiac arrest carries a poor prognosis with limited options for treatment [1, 2]. In addition to controlling temperature after cardiac arrest, optimizing ventilation and oxygenation may improve outcome [3]. Targeting safe levels of carbon dioxide and oxygen in arterial blood may limit global ischemic damage and Helmerhorst et al Critical Care (2015) 19:348 separate and combined effects of both parameters in a multicenter cohort of patients admitted to Dutch ICUs after cardiac arrest
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
