Oxygen Administration in Patients Recovering from Cardiac Arrest: a Narrative Review

Overview

Journal J Intensive Care

Publisher Biomed Central

Specialty Critical Care

Date 2020 Aug 25

PMID 32832091

Citations 5

Authors

Ryo Yamamoto

Jo Yoshizawa

Affiliations

Soon will be listed here.

Abstract

High oxygen tension in blood and/or tissue affects clinical outcomes in several diseases. Thus, the optimal target PaO for patients recovering from cardiac arrest (CA) has been extensively examined. Many patients develop hypoxic brain injury after the return of spontaneous circulation (ROSC); this supports the need for oxygen administration in patients after CA. Insufficient oxygen delivery due to decreased blood flow to cerebral tissue during CA results in hypoxic brain injury. By contrast, hyperoxia may increase dissolved oxygen in the blood and, subsequently, generate reactive oxygen species that are harmful to neuronal cells. This secondary brain injury is particularly concerning. Although several clinical studies demonstrated that hyperoxia during post-CA care was associated with poor neurological outcomes, considerable debate is ongoing because of inconsistent results. Potential reasons for the conflicting results include differences in the definition of hyperoxia, the timing of exposure to hyperoxia, and PaO values used in analyses. Despite the conflicts, exposure to PaO > 300 mmHg through administration of unnecessary oxygen should be avoided because no obvious benefit has been demonstrated. The feasibility of titrating oxygen administration by targeting SpO at approximately 94% in patients recovering from CA has been demonstrated in pilot randomized controlled trials (RCTs). Such protocols should be further examined.

Citing Articles

Relationship between initial red cell distribution width and ΔRDW and mortality in cardiac arrest patients.

Zhong L, Zhang Z, Ji X, Wang H, Xie B, Yang X ESC Heart Fail. 2023; 11(1):433-443.

PMID: 38030411 PMC: 10804170. DOI: 10.1002/ehf2.14602.

Multifaceted functions of Drp1 in hypoxia/ischemia-induced mitochondrial quality imbalance: from regulatory mechanism to targeted therapeutic strategy.

Hao S, Huang H, Ma R, Zeng X, Duan C Mil Med Res. 2023; 10(1):46.

PMID: 37833768 PMC: 10571487. DOI: 10.1186/s40779-023-00482-8.

Early restricted oxygen therapy after resuscitation from cardiac arrest (ER-OXYTRAC): protocol for a stepped-wedge cluster randomised controlled trial.

Yamamoto R, Yamakawa K, Endo A, Homma K, Sato Y, Takemura R BMJ Open. 2023; 13(9):e074475.

PMID: 37714682 PMC: 10510872. DOI: 10.1136/bmjopen-2023-074475.

Hyperoxia for accidental hypothermia and increased mortality: a post-hoc analysis of a multicenter prospective observational study.

Yamamoto R, Yoshizawa J, Takauji S, Hayakawa M, Sasaki J Crit Care. 2023; 27(1):131.

PMID: 37005646 PMC: 10067299. DOI: 10.1186/s13054-023-04407-8.

Hyperoxemia during resuscitation of trauma patients and increased intensive care unit length of stay: inverse probability of treatment weighting analysis.

Yamamoto R, Fujishima S, Sasaki J, Gando S, Saitoh D, Shiraishi A World J Emerg Surg. 2021; 16(1):19.

PMID: 33926507 PMC: 8082221. DOI: 10.1186/s13017-021-00363-2.

References

Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C . Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013; 369(23):2197-206. DOI: 10.1056/NEJMoa1310519. View

Richards E, Fiskum G, Rosenthal R, Hopkins I, McKenna M . Hyperoxic reperfusion after global ischemia decreases hippocampal energy metabolism. Stroke. 2007; 38(5):1578-84. PMC: 2601708. DOI: 10.1161/STROKEAHA.106.473967. View

DellAnna A, Lamanna I, Vincent J, Taccone F . How much oxygen in adult cardiac arrest?. Crit Care. 2015; 18(5):555. PMC: 4520204. DOI: 10.1186/s13054-014-0555-4. View

Gueugniaud P, Garcia-Darennes F, Gaussorgues P, BANCALARI G, Petit P, Robert D . Prognostic significance of early intracranial and cerebral perfusion pressures in post-cardiac arrest anoxic coma. Intensive Care Med. 1991; 17(7):392-8. DOI: 10.1007/BF01720676. View

NEGOVSKY V . The second step in resuscitation--the treatment of the 'post-resuscitation disease'. Resuscitation. 1972; 1(1):1-7. DOI: 10.1016/0300-9572(72)90058-5. View

Diringer M . Hyperoxia: good or bad for the injured brain?. Curr Opin Crit Care. 2008; 14(2):167-71. PMC: 2542895. DOI: 10.1097/MCC.0b013e3282f57552. View

Bray J, Hein C, Smith K, Stephenson M, Grantham H, Finn J . Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial). Resuscitation. 2018; 128:211-215. DOI: 10.1016/j.resuscitation.2018.04.019. View

Severinghaus J . Simple, accurate equations for human blood O2 dissociation computations. J Appl Physiol Respir Environ Exerc Physiol. 1979; 46(3):599-602. DOI: 10.1152/jappl.1979.46.3.599. View

Thomas M, Voss S, Benger J, Kirby K, Nolan J . Cluster randomised comparison of the effectiveness of 100% oxygen versus titrated oxygen in patients with a sustained return of spontaneous circulation following out of hospital cardiac arrest: a feasibility study. PROXY: post ROSC OXYgenation study. BMC Emerg Med. 2019; 19(1):16. PMC: 6347786. DOI: 10.1186/s12873-018-0214-1. View

10.

Christ M, von Auenmueller K, Brand M, Amirie S, Sasko B, Trappe H . Hyperoxia Early After Hospital Admission in Comatose Patients with Non-Traumatic Out-of-Hospital Cardiac Arrest. Med Sci Monit. 2016; 22:3296-300. PMC: 5029200. DOI: 10.12659/msm.897763. View

11.

Vereczki V, Martin E, Rosenthal R, Hof P, Hoffman G, Fiskum G . Normoxic resuscitation after cardiac arrest protects against hippocampal oxidative stress, metabolic dysfunction, and neuronal death. J Cereb Blood Flow Metab. 2005; 26(6):821-35. PMC: 2570707. DOI: 10.1038/sj.jcbfm.9600234. View

12.

Johnson N, Dodampahala K, Rosselot B, Perman S, Mikkelsen M, Goyal M . The Association Between Arterial Oxygen Tension and Neurological Outcome After Cardiac Arrest. Ther Hypothermia Temp Manag. 2016; 7(1):36-41. DOI: 10.1089/ther.2016.0015. View

13.

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

14.

Reinhart K, Bloos F, Konig F, Bredle D, Hannemann L . Reversible decrease of oxygen consumption by hyperoxia. Chest. 1991; 99(3):690-4. DOI: 10.1378/chest.99.3.690. View

15.

von Auenmueller K, Christ M, Sasko B, Trappe H . The Value of Arterial Blood Gas Parameters for Prediction of Mortality in Survivors of Out-of-hospital Cardiac Arrest. J Emerg Trauma Shock. 2017; 10(3):134-139. PMC: 5566022. DOI: 10.4103/JETS.JETS_146_16. View

16.

Brugniaux J, Coombs G, Barak O, Dujic Z, Sekhon M, Ainslie P . Highs and lows of hyperoxia: physiological, performance, and clinical aspects. Am J Physiol Regul Integr Comp Physiol. 2018; 315(1):R1-R27. DOI: 10.1152/ajpregu.00165.2017. View

17.

Nathan C, Cunningham-Bussel A . Beyond oxidative stress: an immunologist's guide to reactive oxygen species. Nat Rev Immunol. 2013; 13(5):349-61. PMC: 4250048. DOI: 10.1038/nri3423. View

18.

Richards E, Rosenthal R, Kristian T, Fiskum G . Postischemic hyperoxia reduces hippocampal pyruvate dehydrogenase activity. Free Radic Biol Med. 2006; 40(11):1960-70. PMC: 2570699. DOI: 10.1016/j.freeradbiomed.2006.01.022. View

19.

Vaahersalo J, Bendel S, Reinikainen M, Kurola J, Tiainen M, Raj R . Arterial blood gas tensions after resuscitation from out-of-hospital cardiac arrest: associations with long-term neurologic outcome. Crit Care Med. 2014; 42(6):1463-70. DOI: 10.1097/CCM.0000000000000228. View

20.

Sekhon M, Ainslie P, Griesdale D . Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a "two-hit" model. Crit Care. 2017; 21(1):90. PMC: 5390465. DOI: 10.1186/s13054-017-1670-9. View