Post-Resuscitation Partial Pressure of Arterial Carbon Dioxide and Outcome in Patients with Out-of-Hospital Cardiac Arrest: A Multicenter Retrospective Cohort Study.

Satoshi Nakajima,Bon Ohta,Tasuku Matsuyama,Asami Okada,Nobunaga Okada,Yohei Okada,Kenji Kandori,Tetsuhisa Kitamura

doi:10.3390/jcm11061523

Abstract

We aimed to estimate the association between PaCO2 level in the patient after out-of-hospital cardiac arrest (OHCA) resuscitation with patient outcome based on a multicenter prospective cohort registry in Japan between June 2014 and December 2015. Based on the PaCO2 within 24 h after return of spontaneous circulation (ROSC), patients were divided into six groups as follows: severe hypocapnia (<25 mmHg), mild hypocapnia (25–35 mmHg,), normocapnia (35–45 mmHg), mild hypercapnia (45–55 mmHg), severe hypercapnia (>55 mmHg), or exposure to both hypocapnia and hypercapnia. Multivariate logistic regression analysis was conducted to calculate the adjusted odds ratios (aORs) and 95% confidence interval (CI) for the 1-month poor neurological outcome (Cerebral Performance Category ≥ 3). Among the 13,491 OHCA patients, 607 were included. Severe hypocapnia, mild hypocapnia, severe hypercapnia, and exposure to both hypocapnia and hypercapnia were associated with a higher rate of 1-month poor neurological outcome compared with mild hypercapnia (aORs 6.68 [95% CI 2.16–20.67], 2.56 [1.30–5.04], 2.62 [1.06–6.47], and 5.63 [2.21–14.34], respectively). There was no significant difference between the outcome of patients with normocapnia and mild hypercapnia. In conclusion, maintaining normocapnia and mild hypercapnia during the 24 h after ROSC was associated with better neurological outcomes than other PaCO2 abnormalities in this study.

Highlights

Population total of 13,491 ofhospital cardiac arrest (OHCA) patients were registered during the study period
The result of sensitivity analysis for OHCA 494 patients without treatment using a mechanical circulatory device was comparable to the main analysis (Table 1, Supplementary Table S1). In this multicenter retrospective observational study of 607 OHCA patients in the Japanese Association for Acute Medicine (JAAM)-OHCA registry, we evaluated whether PaCO2 24 h after return of spontaneous circulation (ROSC) was associated with
In the multivariable logistic regression analysis, we demonstrated that mild hypercapnia exposure (45–55 mmHg) was associated with a lower risk of 1-month poor neurological outcome when compared with the outcome for hypocapnia

Summary

Introduction

Out-of-hospital cardiac arrest (OHCA) is associated with high mortality and poor neurological outcomes [1,2]. Finding appropriate post-resuscitation care to reduce the degree of brain injury after the return of spontaneous circulation (ROSC) from cardiac arrest is important for resuscitation science. In patients after ROSC, partial pressure of arterial carbon dioxide (PaCO2 ) abnormalities such as high PaCO2 due to lack of ventilation during cardiopulmonary arrest and cardiac or respiratory complications, and low PaCO2 due to excessive mechanical ventilation for resuscitation are common [3,4]. In braininjured patients, including OHCA patients, some mechanisms including PaCO2 may 4.0/). Impact cerebral blood flow and perfusion, maintaining PaCO2 could help deliver better neurological outcomes. Recent guidelines by the European Resuscitation Council [5] and the American Heart

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Conclusion