Abstract
Background: Cardiac arrest is a severe condition with high mortality rates, especially in the case of prolonged low-flow durations resulting in severe ischaemia and reperfusion injury. Changes in partial carbon dioxide concentration (pCO2) may aggravate this injury. Extracorporeal cardiopulmonary resuscitation (ECPR) shortens the low-flow duration and enables close regulation of pCO2. We examined whether pCO2 is associated with recovery of consciousness. Methods: We retrospectively analysed ECPR patients ≥ 16 years old treated between 2010 and 2019. We evaluated initial arterial pCO2 and the course of pCO2 ≤ 6 h after initiation of ECPR. The primary outcome was the rate of recovery of consciousness, defined as Glasgow coma scale motor score of six. Results: Out of 99 ECPR patients, 84 patients were eligible for this study. The mean age was 47 years, 63% were male, 93% had a witnessed arrest, 45% had an out-of-hospital cardiac arrest, and 38% had a recovery of consciousness. Neither initial pCO2 (Odds Ratio (OR) 0.93, 95% confidence interval 95% (CI) 0.78–1.08) nor maximum decrease of pCO2 (OR 1.03, 95% CI 0.95–1.13) was associated with the recovery of consciousness. Conclusion: Initial arterial pCO2 and the course of pCO2 in the first six hours after initiation of ECPR were not associated with the recovery of consciousness.
Highlights
Survival and favourable neurological survival after cardiac arrest are highly influenced by low-flow duration and the associated severity of ischaemia and reperfusion injury [1]
This hospital has a local database in which all adult patients treated at the emergency department and/or patients of ≥16 years old admitted to the intensive care unit (ICU) for adults, treated with extracorporeal membrane oxygenation (ECMO) are registered
A total of 84 patients were included in this study, of which 32 (38%) had a recovery of consciousness at the ICU
Summary
Survival and favourable neurological survival after cardiac arrest are highly influenced by low-flow duration and the associated severity of ischaemia and reperfusion injury [1]. This ischaemia and reperfusion injury is influenced by the level and course of partial oxygen pressure (pO2) and partial carbon dioxide pressure (pCO2) during and after cardiopulmonary resuscitation (CPR) [2]. Cardiac arrest is a severe condition with high mortality rates, especially in the case of prolonged low-flow durations resulting in severe ischaemia and reperfusion injury. Conclusion: Initial arterial pCO2 and the course of pCO2 in the first six hours after initiation of ECPR were not associated with the recovery of consciousness
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