Abstract
BackgroundExposure to extreme arterial partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) following the return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) is common and may affect neurological outcome but results of previous studies are conflicting.MethodsExploratory study of the International Cardiac Arrest Registry (INTCAR) 2.0 database, including 2162 OHCA patients with ROSC in 22 intensive care units in North America and Europe. We tested the hypothesis that exposure to extreme PaO2 or PaCO2 values within 24 h after OHCA is associated with poor neurological outcome at discharge. Our primary analyses investigated the association between extreme PaO2 and PaCO2 values, defined as hyperoxemia (PaO2 > 40 kPa), hypoxemia (PaO2 < 8.0 kPa), hypercapnemia (PaCO2 > 6.7 kPa) and hypocapnemia (PaCO2 < 4.0 kPa) and neurological outcome. The secondary analyses tested the association between the exposure combinations of PaO2 > 40 kPa with PaCO2 < 4.0 kPa and PaO2 8.0–40 kPa with PaCO2 > 6.7 kPa and neurological outcome. To define a cut point for the onset of poor neurological outcome, we tested a model with increasing and decreasing PaO2 levels and decreasing PaCO2 levels. Cerebral Performance Category (CPC), dichotomized to good (CPC 1–2) and poor (CPC 3–5) was used as outcome measure.ResultsOf 2135 patients eligible for analysis, 700 were exposed to hyperoxemia or hypoxemia and 1128 to hypercapnemia or hypocapnemia. Our primary analyses did not reveal significant associations between exposure to extreme PaO2 or PaCO2 values and neurological outcome (P = 0.13–0.49). Our secondary analyses showed no significant associations between combinations of PaO2 and PaCO2 and neurological outcome (P = 0.11–0.86). There was no PaO2 or PaCO2 level significantly associated with poor neurological outcome. All analyses were adjusted for relevant co-variates.ConclusionsExposure to extreme PaO2 or PaCO2 values in the first 24 h after OHCA was common, but not independently associated with neurological outcome at discharge.
Highlights
Admission to hospital as well as 30-day survival after out of hospital cardiac arrest (OHCA) has increased in recent years and most 30-day survivors after of-hospital cardiac arrest (OHCA) are discharged with good neurological function [1]
The proportion of patients dying after hospital admission is more than 50 % and the major causes are the primary ischemic cerebral injury sustained during the no-flow time of the OHCA and the additional secondary cerebral reperfusion injury that commences at return of spontaneous circulation (ROSC) [2, 3]
We conducted this study of the International Cardiac Arrest Registry (INTCAR) 2.0 database to investigate the association between exposure to extreme Arterial partial pressure of carbon dioxide (PaCO2) and Arterial partial pressure of oxygen (PaO2) values and neurological outcome at hospital discharge in a large cohort of adult, unconscious patients with sustained ROSC after OHCA
Summary
Admission to hospital as well as 30-day survival after out of hospital cardiac arrest (OHCA) has increased in recent years and most 30-day survivors after OHCA are discharged with good neurological function [1] Despite these advances, the proportion of patients dying after hospital admission is more than 50 % and the major causes are the primary ischemic cerebral injury sustained during the no-flow time of the OHCA and the additional secondary cerebral reperfusion injury that commences at return of spontaneous circulation (ROSC) [2, 3]. We conducted this study of the International Cardiac Arrest Registry (INTCAR) 2.0 database to investigate the association between exposure to extreme PaCO2 and PaO2 values and neurological outcome at hospital discharge in a large cohort of adult, unconscious patients with sustained ROSC after OHCA. Exposure to extreme arterial partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) following the return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) is common and may affect neurological outcome but results of previous studies are conflicting
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