Oxygen targets and 6-month outcome after out of hospital cardiac arrest : a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial
Robba, Chiara ; Lilja, Gisela LU ; Friberg, Hans LU ; Chew, Michelle S. LU ; Unden, Johan LU ; Dankiewicz, Josef LU
; Nielsen, Niklas
LU
; Ebner, Florian
LU
and Pelosi, Paolo
(2022)
In Critical Care
26.
p.1-13
- Abstract
Background: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients’ outcome. Methods: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2... (More)
Background: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients’ outcome. Methods: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). Conclusions: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration: clinicaltrials.gov NCT02908308, Registered September 20, 2016.
(Less)
- author
- Robba, Chiara
; Lilja, Gisela
LU
; Friberg, Hans
LU
; Chew, Michelle S.
LU
; Unden, Johan
LU
; Dankiewicz, Josef
LU
; Nielsen, Niklas
LU
; Ebner, Florian
LU
and Pelosi, Paolo
- contributor
- Cronberg, Tobias
LU
; Erlinge, David
LU
; Levin, Helena
LU
; Nordberg, Per
LU
; Ullén, Susann
LU
; Palmér, Karolina
LU
; Karlsson, Ulla Britt
LU
; Heissler, Simon
LU
; Ceric, Ameldina
LU
; Haxhija, Zana
LU
; Düring, Joachim
LU
; Bergström, Mattias
LU
; Bohm, Mattias
LU
; Didriksson, Ingrid
LU
; Frid, Petrea
LU
; Heimburg, Katarina
LU
; Lundberg, Oscar
LU
; Hau, Stefan Olsson
LU
; Schmidbauer, Simon
LU
; Borgquist, Ola
LU
; Bjärnroos, Anna
LU
; Blennow Nordström, Erik
LU
; Dragancea, Irina
LU
; Kander, Thomas
LU
; Lybeck, Anna
LU
; Mattiasson, Gustav
LU
; Rundgren, Malin
LU
; Westhall, Erik
LU
; Annborn, Martin
LU
; Andertun, Sara
LU
; Johnsson, Jesper
LU
; Unden, Johan
LU
and Wijdicks, Eelco F. M.
- author collaboration
- organization
-
- Brain Injury After Cardiac Arrest (research group)
- Center for cardiac arrest (research group)
- SWECRIT (research group)
- Anaesthesiology and Intensive Care Medicine (research group)
- Cardiology
- SEBRA Sepsis and Bacterial Resistance Alliance (research group)
- Anesthesiology and Intensive Care
- Clinical Sciences, Helsingborg
- Molecular Cardiology (research group)
- Family Medicine and Clinical Epidemiology (research group)
- Neurology, Lund
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cardiac arrest, Hyperoxemia, Hypoxemia, Mortality, Neurological outcome
- in
- Critical Care
- volume
- 26
- article number
- 323
- pages
- 1 - 13
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:36271410
- scopus:85140287744
- ISSN
- 1364-8535
- DOI
- 10.1186/s13054-022-04186-8
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2022, The Author(s).
- id
- 4949a1e5-f4a6-4606-88ef-9290ff027aee
- date added to LUP
- 2022-11-24 22:28:07
- date last changed
- 2024-04-24 02:54:25
@article{4949a1e5-f4a6-4606-88ef-9290ff027aee,
abstract = {{<p>Background: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO<sub>2</sub>) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO<sub>2</sub> with patients’ outcome. Methods: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO<sub>2</sub> < 60 mmHg and severe hyperoxemia as PaO<sub>2</sub> > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO<sub>2</sub>-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). Conclusions: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration: clinicaltrials.gov NCT02908308, Registered September 20, 2016.</p>}},
author = {{Robba, Chiara and Lilja, Gisela and Friberg, Hans and Chew, Michelle S. and Unden, Johan and Dankiewicz, Josef and Nielsen, Niklas and Ebner, Florian and Pelosi, Paolo}},
issn = {{1364-8535}},
keywords = {{Cardiac arrest; Hyperoxemia; Hypoxemia; Mortality; Neurological outcome}},
language = {{eng}},
pages = {{1--13}},
publisher = {{BioMed Central (BMC)}},
series = {{Critical Care}},
title = {{Oxygen targets and 6-month outcome after out of hospital cardiac arrest : a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial}},
url = {{http://dx.doi.org/10.1186/s13054-022-04186-8}},
doi = {{10.1186/s13054-022-04186-8}},
volume = {{26}},
year = {{2022}},
}