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The association of partial pressures of oxygen and carbon dioxide with neurological outcome after out-of-hospital cardiac arrest : an explorative International Cardiac Arrest Registry 2.0 study

Ebner, Florian LU ; Riker, Richard R. ; Haxhija, Zana ; Seder, David B. ; May, Teresa L. ; Ullén, Susann LU ; Stammet, Pascal ; Hirsch, Karen ; Forsberg, Sune and Dupont, Allison , et al. (2020) In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 28(1). p.67-67
Abstract

BACKGROUND: 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.

METHODS: Exploratory 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... (More)

BACKGROUND: 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.

METHODS: Exploratory 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.

RESULTS: Of 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.

CONCLUSIONS: Exposure to extreme PaO2 or PaCO2 values in the first 24 h after OHCA was common, but not independently associated with neurological outcome at discharge.

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Contribution to journal
publication status
published
subject
keywords
Aged, Arterial Pressure/physiology, Blood Gas Analysis/methods, Carbon Dioxide/analysis, Cardiopulmonary Resuscitation/methods, Europe, Female, Humans, Hypercapnia/diagnosis, Intensive Care Units, Male, Middle Aged, Out-of-Hospital Cardiac Arrest/complications, Oxygen/analysis, Partial Pressure, Registries
in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
volume
28
issue
1
article number
67
pages
67 - 67
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85088038638
  • pmid:32664989
ISSN
1757-7241
DOI
10.1186/s13049-020-00760-7
language
English
LU publication?
yes
id
6dcd8c5d-9ec0-4fbf-bf85-67f2ead85c45
date added to LUP
2020-07-28 13:05:29
date last changed
2024-04-03 10:45:50
@article{6dcd8c5d-9ec0-4fbf-bf85-67f2ead85c45,
  abstract     = {{<p>BACKGROUND: 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.</p><p>METHODS: Exploratory 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 &gt; 40 kPa), hypoxemia (PaO2 &lt; 8.0 kPa), hypercapnemia (PaCO2 &gt; 6.7 kPa) and hypocapnemia (PaCO2 &lt; 4.0 kPa) and neurological outcome. The secondary analyses tested the association between the exposure combinations of PaO2 &gt; 40 kPa with PaCO2 &lt; 4.0 kPa and PaO2 8.0-40 kPa with PaCO2 &gt; 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.</p><p>RESULTS: Of 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.</p><p>CONCLUSIONS: Exposure to extreme PaO2 or PaCO2 values in the first 24 h after OHCA was common, but not independently associated with neurological outcome at discharge.</p>}},
  author       = {{Ebner, Florian and Riker, Richard R. and Haxhija, Zana and Seder, David B. and May, Teresa L. and Ullén, Susann and Stammet, Pascal and Hirsch, Karen and Forsberg, Sune and Dupont, Allison and Friberg, Hans and McPherson, John A. and Søreide, Eldar and Dankiewicz, Josef and Cronberg, Tobias and Nielsen, Niklas}},
  issn         = {{1757-7241}},
  keywords     = {{Aged; Arterial Pressure/physiology; Blood Gas Analysis/methods; Carbon Dioxide/analysis; Cardiopulmonary Resuscitation/methods; Europe; Female; Humans; Hypercapnia/diagnosis; Intensive Care Units; Male; Middle Aged; Out-of-Hospital Cardiac Arrest/complications; Oxygen/analysis; Partial Pressure; Registries}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{1}},
  pages        = {{67--67}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine}},
  title        = {{The association of partial pressures of oxygen and carbon dioxide with neurological outcome after out-of-hospital cardiac arrest : an explorative International Cardiac Arrest Registry 2.0 study}},
  url          = {{http://dx.doi.org/10.1186/s13049-020-00760-7}},
  doi          = {{10.1186/s13049-020-00760-7}},
  volume       = {{28}},
  year         = {{2020}},
}