Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest
(2023) In New England Journal of Medicine 389(1). p.45-57- Abstract
- Abstract Background Guidelines recommend normocapnia for adults with coma who are resuscitated after out-of-hospital cardiac arrest. However, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes. Methods We randomly assigned adults with coma who had been resuscitated after out-of-hospital cardiac arrest of presumed cardiac or unknown cause and admitted to the intensive care unit (ICU) in a 1:1 ratio to either 24 hours of mild hypercapnia (target partial pressure of arterial carbon dioxide [Paco2], 50 to 55 mm Hg) or normocapnia (target Paco2, 35 to 45 mm Hg). The primary outcome was a favorable neurologic outcome, defined as a score of 5 (indicating lower moderate disability) or higher, as assessed with the... (More)
- Abstract Background Guidelines recommend normocapnia for adults with coma who are resuscitated after out-of-hospital cardiac arrest. However, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes. Methods We randomly assigned adults with coma who had been resuscitated after out-of-hospital cardiac arrest of presumed cardiac or unknown cause and admitted to the intensive care unit (ICU) in a 1:1 ratio to either 24 hours of mild hypercapnia (target partial pressure of arterial carbon dioxide [Paco2], 50 to 55 mm Hg) or normocapnia (target Paco2, 35 to 45 mm Hg). The primary outcome was a favorable neurologic outcome, defined as a score of 5 (indicating lower moderate disability) or higher, as assessed with the use of the Glasgow Outcome Scale-Extended (range, 1 [death] to 8, with higher scores indicating better neurologic outcome) at 6 months. Secondary outcomes included death within 6 months. Results A total of 1700 patients from 63 ICUs in 17 countries were recruited, with 847 patients assigned to targeted mild hypercapnia and 853 to targeted normocapnia. A favorable neurologic outcome at 6 months occurred in 332 of 764 patients (43.5%) in the mild hypercapnia group and in 350 of 784 (44.6%) in the normocapnia group (relative risk, 0.98; 95% confidence interval [CI], 0.87 to 1.11; P=0.76). Death within 6 months after randomization occurred in 393 of 816 patients (48.2%) in the mild hypercapnia group and in 382 of 832 (45.9%) in the normocapnia group (relative risk, 1.05; 95% CI, 0.94 to 1.16). The incidence of adverse events did not differ significantly between groups. Conclusions In patients with coma who were resuscitated after out-of-hospital cardiac arrest, targeted mild hypercapnia did not lead to better neurologic outcomes at 6 months than targeted normocapnia. (Funded by the National Health and Medical Research Council of Australia and others; TAME ClinicalTrials.gov number, NCT03114033.). (Less)
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- author
- Eastwood, G. ; Lilja, G. LU ; Cronberg, T. LU ; Fahey, C. and Bellomo, R.
- author collaboration
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cardiac Arrest, Cardiology, Cardiology General, Clinical Medicine, Clinical Medicine General, Coma/Brain Death, Critical Care, Emergency Medicine, Emergency Medicine General, Hospital-Based Clinical Medicine, Neurology/Neurosurgery, Neurology/Neurosurgery General, Pulmonary/Critical Care, adult, adverse event, arterial carbon dioxide tension, Article, clinical feature, clinical outcome, coma, controlled study, female, Glasgow outcome scale, human, hypercapnia, incidence, intensive care unit, length of stay, life sustaining treatment, major clinical study, male, middle aged, mortality, open study, out of hospital cardiac arrest, outcome assessment, prognosis, randomized controlled trial, risk factor
- in
- New England Journal of Medicine
- volume
- 389
- issue
- 1
- pages
- 13 pages
- publisher
- Massachusetts Medical Society
- external identifiers
-
- scopus:85164131143
- pmid:37318140
- ISSN
- 0028-4793
- DOI
- 10.1056/NEJMoa2214552
- language
- English
- LU publication?
- yes
- id
- c83886b3-1e92-402b-96f3-ebe2e62a7515
- date added to LUP
- 2024-01-16 14:41:52
- date last changed
- 2024-01-17 03:00:57
@article{c83886b3-1e92-402b-96f3-ebe2e62a7515,
abstract = {{Abstract Background Guidelines recommend normocapnia for adults with coma who are resuscitated after out-of-hospital cardiac arrest. However, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes. Methods We randomly assigned adults with coma who had been resuscitated after out-of-hospital cardiac arrest of presumed cardiac or unknown cause and admitted to the intensive care unit (ICU) in a 1:1 ratio to either 24 hours of mild hypercapnia (target partial pressure of arterial carbon dioxide [Paco2], 50 to 55 mm Hg) or normocapnia (target Paco2, 35 to 45 mm Hg). The primary outcome was a favorable neurologic outcome, defined as a score of 5 (indicating lower moderate disability) or higher, as assessed with the use of the Glasgow Outcome Scale-Extended (range, 1 [death] to 8, with higher scores indicating better neurologic outcome) at 6 months. Secondary outcomes included death within 6 months. Results A total of 1700 patients from 63 ICUs in 17 countries were recruited, with 847 patients assigned to targeted mild hypercapnia and 853 to targeted normocapnia. A favorable neurologic outcome at 6 months occurred in 332 of 764 patients (43.5%) in the mild hypercapnia group and in 350 of 784 (44.6%) in the normocapnia group (relative risk, 0.98; 95% confidence interval [CI], 0.87 to 1.11; P=0.76). Death within 6 months after randomization occurred in 393 of 816 patients (48.2%) in the mild hypercapnia group and in 382 of 832 (45.9%) in the normocapnia group (relative risk, 1.05; 95% CI, 0.94 to 1.16). The incidence of adverse events did not differ significantly between groups. Conclusions In patients with coma who were resuscitated after out-of-hospital cardiac arrest, targeted mild hypercapnia did not lead to better neurologic outcomes at 6 months than targeted normocapnia. (Funded by the National Health and Medical Research Council of Australia and others; TAME ClinicalTrials.gov number, NCT03114033.).}},
author = {{Eastwood, G. and Lilja, G. and Cronberg, T. and Fahey, C. and Bellomo, R.}},
issn = {{0028-4793}},
keywords = {{Cardiac Arrest; Cardiology; Cardiology General; Clinical Medicine; Clinical Medicine General; Coma/Brain Death; Critical Care; Emergency Medicine; Emergency Medicine General; Hospital-Based Clinical Medicine; Neurology/Neurosurgery; Neurology/Neurosurgery General; Pulmonary/Critical Care; adult; adverse event; arterial carbon dioxide tension; Article; clinical feature; clinical outcome; coma; controlled study; female; Glasgow outcome scale; human; hypercapnia; incidence; intensive care unit; length of stay; life sustaining treatment; major clinical study; male; middle aged; mortality; open study; out of hospital cardiac arrest; outcome assessment; prognosis; randomized controlled trial; risk factor}},
language = {{eng}},
number = {{1}},
pages = {{45--57}},
publisher = {{Massachusetts Medical Society}},
series = {{New England Journal of Medicine}},
title = {{Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest}},
url = {{http://dx.doi.org/10.1056/NEJMoa2214552}},
doi = {{10.1056/NEJMoa2214552}},
volume = {{389}},
year = {{2023}},
}