Post-Resuscitation Arterial Oxygen and Carbon Dioxide and Outcomes After Out-of-Hospital Cardiac Arrest
Document Type
Article
Publication Date
1-11-2017
Identifier/URL
39843093 (Pure); 7e698e19-abfc-4a22-bfbd-f142c3a5c698 (collected_work_id); 85029681608 (Scopus)
Abstract
Objective
To determine if arterial oxygen and carbon dioxide abnormalities in the first 24 h 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 ≥1 h after Emergency Department arrival and at least one arterial blood gas (ABG) measurement. Among ABGs measured during the first 24 h of hospitalization, we identified the presence of hyperoxemia (PaO2 ≥ 300 mmHg), hypoxemia (PaO2 < 60 mmHg), hypercarbia (PaCO2 > 50 mmHg) and hypocarbia (PaCO2 < 30 mmHg). 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 < 60 mmHg) 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 > 50 mmHg) 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 < 30 mmHg) were not associated with hospital mortality.
Conclusions
In the first 24 h after ROSC, abnormal post-arrest oxygen and carbon dioxide tensions are associated with increased out of-hospital cardiac arrest mortality.
Repository Citation
Wang, H. E.,
Prince, D. K.,
Drennan, I. R.,
Grunau, B.,
Carlbom, D. J.,
Johnson, N.,
Hansen, M.,
Elmer, J.,
Christenson, J.,
Kudenchuk, P.,
Aufderheide, T.,
Weisfeldt, M.,
Idris, A.,
Trzeciak, S.,
Kurz, M.,
Rittenberger, J. C.,
Griffiths, D.,
Jasti, J.,
May, S.,
& Griffith, D.
(2017). Post-Resuscitation Arterial Oxygen and Carbon Dioxide and Outcomes After Out-of-Hospital Cardiac Arrest. Resuscitation, 120.
https://corescholar.libraries.wright.edu/familymed/289
DOI
10.1016/j.resuscitation.2017.08.244
