Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Effects of very early hyperoxemia on neurologic outcome after out-of-hospital cardiac arrest : A secondary analysis of the TTM-2 trial

Sanfilippo, Filippo ; Uryga, Agnieszka ; Santonocito, Cristina ; Jakobsen, Janus Christian ; Lilja, Gisela LU ; Friberg, Hans LU ; Wendel-Garcia, Pedro David ; Young, Paul J. ; Eastwood, Glenn and Chew, Michelle S. LU , et al. (2024) In Resuscitation
Abstract

Purpose: Hyperoxemia is common in patients resuscitated after out-of-hospital cardiac arrest (OHCA) admitted to the intensive care unit (ICU) and may increase the risk of mortality. However, the effect of hyperoxemia on functional outcome, specifically related to the timing of exposure to hyperoxemia, remains unclear. Methods: The secondary analysis of the Target Temperature Management 2 (TTM-2) randomized trial. The primary aim was to identify the best cut-off of partial arterial pressure of oxygen (PaO2) to predict poor functional outcome within the first 24 h from admission, with this period further separated into ‘very early’ (0–4 h), ‘early’ (8–24 h), and ‘late’ (28–72 h) periods. Hyperoxemia was defined as the highest... (More)

Purpose: Hyperoxemia is common in patients resuscitated after out-of-hospital cardiac arrest (OHCA) admitted to the intensive care unit (ICU) and may increase the risk of mortality. However, the effect of hyperoxemia on functional outcome, specifically related to the timing of exposure to hyperoxemia, remains unclear. Methods: The secondary analysis of the Target Temperature Management 2 (TTM-2) randomized trial. The primary aim was to identify the best cut-off of partial arterial pressure of oxygen (PaO2) to predict poor functional outcome within the first 24 h from admission, with this period further separated into ‘very early’ (0–4 h), ‘early’ (8–24 h), and ‘late’ (28–72 h) periods. Hyperoxemia was defined as the highest PaO2 recorded during each period. Poor functional outcome was defined as a 6 months modified Rankin Score (mRS) of 4 to 6. Results: A total of 1,631 patients were analysed for the ‘very early’ and ‘early’ periods, and 1,591 in the ‘late period’. In a multivariate logistic regression model, a PaO2 above 245 mmHg during the very early phase was independently associated with a higher probability of poor functional outcome (Odds Ratio, OR = 1.63, 95 % Confidence Interval, CI 1.08–2.44, p = 0.019). No significant associations were found for the later periods. Conclusions: Very early hyperoxemia after ICU admission is associated with higher risk of poor functional outcome after OHCA. Avoiding hyperoxia in the initial hours after resuscitation should be considered.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; and (Less)
author collaboration
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Cardiac arrest, Functional outcome, Oxygen radicals, Oxygenation, Timing
in
Resuscitation
article number
110460
publisher
Elsevier
external identifiers
  • scopus:85212338674
  • pmid:39653237
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2024.110460
language
English
LU publication?
yes
id
e846a6c2-3666-41c2-9a02-ef02baaf60c2
date added to LUP
2025-01-29 12:23:17
date last changed
2025-06-04 22:12:30
@article{e846a6c2-3666-41c2-9a02-ef02baaf60c2,
  abstract     = {{<p>Purpose: Hyperoxemia is common in patients resuscitated after out-of-hospital cardiac arrest (OHCA) admitted to the intensive care unit (ICU) and may increase the risk of mortality. However, the effect of hyperoxemia on functional outcome, specifically related to the timing of exposure to hyperoxemia, remains unclear. Methods: The secondary analysis of the Target Temperature Management 2 (TTM-2) randomized trial. The primary aim was to identify the best cut-off of partial arterial pressure of oxygen (PaO<sub>2</sub>) to predict poor functional outcome within the first 24 h from admission, with this period further separated into ‘very early’ (0–4 h), ‘early’ (8–24 h), and ‘late’ (28–72 h) periods. Hyperoxemia was defined as the highest PaO<sub>2</sub> recorded during each period. Poor functional outcome was defined as a 6 months modified Rankin Score (mRS) of 4 to 6. Results: A total of 1,631 patients were analysed for the ‘very early’ and ‘early’ periods, and 1,591 in the ‘late period’. In a multivariate logistic regression model, a PaO<sub>2</sub> above 245 mmHg during the very early phase was independently associated with a higher probability of poor functional outcome (Odds Ratio, OR = 1.63, 95 % Confidence Interval, CI 1.08–2.44, p = 0.019). No significant associations were found for the later periods. Conclusions: Very early hyperoxemia after ICU admission is associated with higher risk of poor functional outcome after OHCA. Avoiding hyperoxia in the initial hours after resuscitation should be considered.</p>}},
  author       = {{Sanfilippo, Filippo and Uryga, Agnieszka and Santonocito, Cristina and Jakobsen, Janus Christian and Lilja, Gisela and Friberg, Hans and Wendel-Garcia, Pedro David and Young, Paul J. and Eastwood, Glenn and Chew, Michelle S. and Unden, Johan and Thomas, Matthew and Grejs, Anders M. and Wise, Matt P. and Lundin, Andreas and Hollenberg, Jacob and Hammond, Naomi and Saxena, Manoj and Martin, Annborn and Bánszky, Robert and Taccone, Fabio Silvio and Dankiewicz, Josef and Nielsen, Niklas and Ebner, Florian and BeloholaveK, Jan and Hanggi, Matthias and Montagnani, Luca and Patroniti, Nicolo’ and Robba, Chiara}},
  issn         = {{0300-9572}},
  keywords     = {{Cardiac arrest; Functional outcome; Oxygen radicals; Oxygenation; Timing}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Effects of very early hyperoxemia on neurologic outcome after out-of-hospital cardiac arrest : A secondary analysis of the TTM-2 trial}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2024.110460}},
  doi          = {{10.1016/j.resuscitation.2024.110460}},
  year         = {{2024}},
}