Hyperoxia is Associated with Increased Mortality in Patients Treated with Mild Therapeutic Hypothermia After Sudden Cardiac Arrest

Overview

Journal Crit Care Med

Specialties Critical Care
Emergency Medicine

Date 2012 Sep 14

PMID 22971589

Citations 71

Authors

David R Janz

Ryan D Hollenbeck

Jeremy S Pollock

John A McPherson

Todd W Rice

Affiliations

Soon will be listed here.

Abstract

Objective: To determine whether higher levels of PaO2 are associated with in-hospital mortality and poor neurological status at hospital discharge in patients treated with mild therapeutic hypothermia after sudden cardiac arrest.

Design: Retrospective analysis of a prospective cohort.

Patients: A total of 170 consecutive patients treated with therapeutic hypothermia in the cardiovascular care unit of an academic tertiary care hospital.

Interventions: None.

Measurements And Main Results: Of 170 patients, 77 (45.2%) survived to hospital discharge. Survivors had a significantly lower maximum PaO2 (198 mm Hg; interquartile range, 152.5-282) measured in the first 24 hrs following cardiac arrest compared to nonsurvivors (254 mm Hg; interquartile range, 172-363; p = .022). A multivariable analysis including age, time to return of spontaneous circulation, the presence of shock, bystander cardiopulmonary resuscitation, and initial rhythm revealed that higher levels of PaO2 were significantly associated with increased in-hospital mortality (odds ratio 1.439; 95% confidence interval 1.028-2.015; p = .034) and poor neurological status at hospital discharge (odds ratio 1.485; 95% confidence interval 1.032-2.136; p = .033).

Conclusions: Higher levels of the maximum measured PaO2 are associated with increased in-hospital mortality and poor neurological status on hospital discharge in patients treated with mild therapeutic hypothermia after sudden cardiac arrest.

Citing Articles

Extracorporeal Life Support for Cardiac Arrest and Cardiogenic Shock.

Elliott A, Dahyia G, Kalra R, Alexy T, Bartos J, Kosmopoulos M US Cardiol. 2024; 15:e23.

PMID: 39720488 PMC: 11664775. DOI: 10.15420/usc.2021.13.

Management of Patients With Cardiac Arrest Requiring Interfacility Transport: A Scientific Statement From the American Heart Association.

May T, Bressler E, Cash R, Guyette F, Lin S, Morris N Circulation. 2024; 150(18):e316-e327.

PMID: 39297198 PMC: 11669938. DOI: 10.1161/CIR.0000000000001282.

Machine Learning and Clinical Predictors of Mortality in Cardiac Arrest Patients: A Comprehensive Analysis.

Lewandowski L, Czapla M, Uchmanowicz I, Kubielas G, Zielinski S, Krzystek-Korpacka M Med Sci Monit. 2024; 30:e944408.

PMID: 39126147 PMC: 11323708. DOI: 10.12659/MSM.944408.

Optimal inhaled oxygen and carbon dioxide concentrations for post-cardiac arrest cerebral reoxygenation and neurological recovery.

Wang C, Chang W, Huang C, Tsai M, Wang C, Liu S iScience. 2024; 26(12):108476.

PMID: 38187189 PMC: 10767205. DOI: 10.1016/j.isci.2023.108476.

Effects of Conservative Oxygen Therapy versus Conventional Oxygen Therapy on the Mortality in ICU Patients: A Meta-Analysis.

Jiang X, Qiu D Can Respir J. 2023; 2023:7023712.

PMID: 37868784 PMC: 10590270. DOI: 10.1155/2023/7023712.

References

Fran Hazinski M, Nolan J, Billi J, Bottiger B, Bossaert L, de Caen A . Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010; 122(16 Suppl 2):S250-75. DOI: 10.1161/CIRCULATIONAHA.110.970897. View

Stegman B, Newby L, Hochman J, Ohman E . Post-myocardial infarction cardiogenic shock is a systemic illness in need of systemic treatment: is therapeutic hypothermia one possibility?. J Am Coll Cardiol. 2012; 59(7):644-7. DOI: 10.1016/j.jacc.2011.11.010. View

Polderman K . Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med. 2009; 37(7 Suppl):S186-202. DOI: 10.1097/CCM.0b013e3181aa5241. View

Stiell I, Wells G, Field B, Spaite D, Nesbitt L, De Maio V . Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med. 2004; 351(7):647-56. DOI: 10.1056/NEJMoa040325. View

Balan I, Fiskum G, Hazelton J, Cotto-Cumba C, Rosenthal R . Oximetry-guided reoxygenation improves neurological outcome after experimental cardiac arrest. Stroke. 2006; 37(12):3008-13. PMC: 2600845. DOI: 10.1161/01.STR.0000248455.73785.b1. View

Rawles J, Kenmure A . Controlled trial of oxygen in uncomplicated myocardial infarction. Br Med J. 1976; 1(6018):1121-3. PMC: 1639993. DOI: 10.1136/bmj.1.6018.1121. View

Wagner P, Laravuso R, Uhl R, West J . Continuous distributions of ventilation-perfusion ratios in normal subjects breathing air and 100 per cent O2. J Clin Invest. 1974; 54(1):54-68. PMC: 301524. DOI: 10.1172/JCI107750. View

Mongardon N, Perbet S, Lemiale V, Dumas F, Poupet H, Charpentier J . Infectious complications in out-of-hospital cardiac arrest patients in the therapeutic hypothermia era. Crit Care Med. 2011; 39(6):1359-64. DOI: 10.1097/CCM.0b013e3182120b56. View

Floyd T, Clark J, Gelfand R, Detre J, Ratcliffe S, Guvakov D . Independent cerebral vasoconstrictive effects of hyperoxia and accompanying arterial hypocapnia at 1 ATA. J Appl Physiol (1985). 2003; 95(6):2453-61. DOI: 10.1152/japplphysiol.00303.2003. View

10.

Nolan J, Neumar R, Adrie C, Aibiki M, Berg R, Bottiger B . Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee;.... Resuscitation. 2008; 79(3):350-79. DOI: 10.1016/j.resuscitation.2008.09.017. View

11.

Becker L, Aufderheide T, Geocadin R, Callaway C, Lazar R, Donnino M . Primary outcomes for resuscitation science studies: a consensus statement from the American Heart Association. Circulation. 2011; 124(19):2158-77. PMC: 3719404. DOI: 10.1161/CIR.0b013e3182340239. View

12.

Kloeck W, Billi J, Bottiger B, Morley P, Nolan J, Okada K . Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation. Circulation. 2003; 108(1):118-21. DOI: 10.1161/01.CIR.0000079019.02601.90. View

13.

Kilgannon J, Jones A, Parrillo J, Dellinger R, Milcarek B, Hunter K . Relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest. Circulation. 2011; 123(23):2717-22. DOI: 10.1161/CIRCULATIONAHA.110.001016. View

14.

Merchant R, Becker L, Abella B, Asch D, Groeneveld P . Cost-effectiveness of therapeutic hypothermia after cardiac arrest. Circ Cardiovasc Qual Outcomes. 2009; 2(5):421-8. DOI: 10.1161/CIRCOUTCOMES.108.839605. View

15.

Kilgannon J, Jones A, Shapiro N, Angelos M, Milcarek B, Hunter K . Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA. 2010; 303(21):2165-71. DOI: 10.1001/jama.2010.707. View

16.

Johnston A, Steiner L, Gupta A, Menon D . Cerebral oxygen vasoreactivity and cerebral tissue oxygen reactivity. Br J Anaesth. 2003; 90(6):774-86. DOI: 10.1093/bja/aeg104. View

17.

Bernard S, Gray T, Buist M, Jones B, Silvester W, Gutteridge G . Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; 346(8):557-63. DOI: 10.1056/NEJMoa003289. View

18.

Eastwood G, Bellomo R, Bailey M, Taori G, Pilcher D, Young P . Arterial oxygen tension and mortality in mechanically ventilated patients. Intensive Care Med. 2011; 38(1):91-8. DOI: 10.1007/s00134-011-2419-6. View

19.

Liu L, Yenari M . Therapeutic hypothermia: neuroprotective mechanisms. Front Biosci. 2006; 12:816-25. DOI: 10.2741/2104. View

20.

Trzeciak S, Jones A, Kilgannon J, Milcarek B, Hunter K, Shapiro N . Significance of arterial hypotension after resuscitation from cardiac arrest. Crit Care Med. 2009; 37(11):2895-903. DOI: 10.1097/ccm.0b013e3181b01d8c. View