Post-resuscitation arterial oxygen and carbon dioxide and outcomes after out-of-hospital cardiac arrest

the Resuscitation Outcomes Consortium (ROC) Investigators

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective To determine if arterial oxygen and carbon dioxide abnormalities in the first 24 h after return of spontaneous circulation (ROSC) are associated with increased mortality in adult out-of-hospital cardiac arrest (OHCA). Methods We used data from the Resuscitation Outcomes Consortium (ROC), including adult OHCA with sustained ROSC ≥1 h after Emergency Department arrival and at least one arterial blood gas (ABG) measurement. Among ABGs measured during the first 24 h of hospitalization, we identified the presence of hyperoxemia (PaO2 ≥ 300 mmHg), hypoxemia (PaO2 < 60 mmHg), hypercarbia (PaCO2 > 50 mmHg) and hypocarbia (PaCO2 < 30 mmHg). We evaluated the associations between oxygen and carbon dioxide abnormalities and hospital mortality, adjusting for confounders. Results Among 9186 OHCA included in the analysis, hospital mortality was 67.3%. Hyperoxemia, hypoxemia, hypercarbia, and hypocarbia occurred in 26.5%, 19.0%, 51.0% and 30.6%, respectively. Initial hyperoxemia only was not associated with hospital mortality (adjusted OR 1.10; 95% CI: 0.97–1.26). However, final and any hyperoxemia (1.25; 1.11–1.41) were associated with increased hospital mortality. Initial (1.58; 1.30–1.92), final (3.06; 2.42–3.86) and any (1.76; 1.54–2.02) hypoxemia (PaO2 < 60 mmHg) were associated with increased hospital mortality. Initial (1.89; 1.70–2.10); final (2.57; 2.18–3.04) and any (1.85; 1.67–2.05) hypercarbia (PaCO2 > 50 mmHg) were associated with increased hospital mortality. Initial (1.13; 0.90–1.41), final (1.19; 1.04–1.37) and any (1.01; 0.91–1.12) hypocarbia (PaCO2 < 30 mmHg) were not associated with hospital mortality. Conclusions In the first 24 h after ROSC, abnormal post-arrest oxygen and carbon dioxide tensions are associated with increased out of-hospital cardiac arrest mortality.

Original languageEnglish (US)
Pages (from-to)113-118
Number of pages6
JournalResuscitation
Volume120
DOIs
StatePublished - Nov 1 2017

Fingerprint

Out-of-Hospital Cardiac Arrest
Carbon Dioxide
Resuscitation
Oxygen
Hospital Mortality
Mortality
Hospital Emergency Service
Hospitalization
Gases

Keywords

  • Cardiopulmonary arrest
  • Hypercarbia
  • Hyperoxemia
  • Hypocarbia
  • Hypoxemia
  • Post-arrest care

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Post-resuscitation arterial oxygen and carbon dioxide and outcomes after out-of-hospital cardiac arrest. / the Resuscitation Outcomes Consortium (ROC) Investigators.

In: Resuscitation, Vol. 120, 01.11.2017, p. 113-118.

Research output: Contribution to journalArticle

the Resuscitation Outcomes Consortium (ROC) Investigators. / Post-resuscitation arterial oxygen and carbon dioxide and outcomes after out-of-hospital cardiac arrest. In: Resuscitation. 2017 ; Vol. 120. pp. 113-118.
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title = "Post-resuscitation arterial oxygen and carbon dioxide and outcomes after out-of-hospital cardiac arrest",
abstract = "Objective To determine if arterial oxygen and carbon dioxide abnormalities in the first 24 h after return of spontaneous circulation (ROSC) are associated with increased mortality in adult out-of-hospital cardiac arrest (OHCA). Methods We used data from the Resuscitation Outcomes Consortium (ROC), including adult OHCA with sustained ROSC ≥1 h after Emergency Department arrival and at least one arterial blood gas (ABG) measurement. Among ABGs measured during the first 24 h of hospitalization, we identified the presence of hyperoxemia (PaO2 ≥ 300 mmHg), hypoxemia (PaO2 < 60 mmHg), hypercarbia (PaCO2 > 50 mmHg) and hypocarbia (PaCO2 < 30 mmHg). We evaluated the associations between oxygen and carbon dioxide abnormalities and hospital mortality, adjusting for confounders. Results Among 9186 OHCA included in the analysis, hospital mortality was 67.3{\%}. Hyperoxemia, hypoxemia, hypercarbia, and hypocarbia occurred in 26.5{\%}, 19.0{\%}, 51.0{\%} and 30.6{\%}, respectively. Initial hyperoxemia only was not associated with hospital mortality (adjusted OR 1.10; 95{\%} CI: 0.97–1.26). However, final and any hyperoxemia (1.25; 1.11–1.41) were associated with increased hospital mortality. Initial (1.58; 1.30–1.92), final (3.06; 2.42–3.86) and any (1.76; 1.54–2.02) hypoxemia (PaO2 < 60 mmHg) were associated with increased hospital mortality. Initial (1.89; 1.70–2.10); final (2.57; 2.18–3.04) and any (1.85; 1.67–2.05) hypercarbia (PaCO2 > 50 mmHg) were associated with increased hospital mortality. Initial (1.13; 0.90–1.41), final (1.19; 1.04–1.37) and any (1.01; 0.91–1.12) hypocarbia (PaCO2 < 30 mmHg) were not associated with hospital mortality. Conclusions In the first 24 h after ROSC, abnormal post-arrest oxygen and carbon dioxide tensions are associated with increased out of-hospital cardiac arrest mortality.",
keywords = "Cardiopulmonary arrest, Hypercarbia, Hyperoxemia, Hypocarbia, Hypoxemia, Post-arrest care",
author = "{the Resuscitation Outcomes Consortium (ROC) Investigators} and Wang, {Henry E.} and Prince, {David K.} and Drennan, {Ian R.} and Brian Grunau and Carlbom, {David J.} and Nicholas Johnson and Matthew Hansen and Jonathan Elmer and Jim Christenson and Peter Kudenchuk and Tom Aufderheide and Myron Weisfeldt and Ahamed Idris and Stephen Trzeciak and Michael Kurz and Rittenberger, {Jon C.} and Denise Griffiths and Jamie Jasti and Susanne May",
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T1 - Post-resuscitation arterial oxygen and carbon dioxide and outcomes after out-of-hospital cardiac arrest

AU - the Resuscitation Outcomes Consortium (ROC) Investigators

AU - Wang, Henry E.

AU - Prince, David K.

AU - Drennan, Ian R.

AU - Grunau, Brian

AU - Carlbom, David J.

AU - Johnson, Nicholas

AU - Hansen, Matthew

AU - Elmer, Jonathan

AU - Christenson, Jim

AU - Kudenchuk, Peter

AU - Aufderheide, Tom

AU - Weisfeldt, Myron

AU - Idris, Ahamed

AU - Trzeciak, Stephen

AU - Kurz, Michael

AU - Rittenberger, Jon C.

AU - Griffiths, Denise

AU - Jasti, Jamie

AU - May, Susanne

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Objective To determine if arterial oxygen and carbon dioxide abnormalities in the first 24 h after return of spontaneous circulation (ROSC) are associated with increased mortality in adult out-of-hospital cardiac arrest (OHCA). Methods We used data from the Resuscitation Outcomes Consortium (ROC), including adult OHCA with sustained ROSC ≥1 h after Emergency Department arrival and at least one arterial blood gas (ABG) measurement. Among ABGs measured during the first 24 h of hospitalization, we identified the presence of hyperoxemia (PaO2 ≥ 300 mmHg), hypoxemia (PaO2 < 60 mmHg), hypercarbia (PaCO2 > 50 mmHg) and hypocarbia (PaCO2 < 30 mmHg). We evaluated the associations between oxygen and carbon dioxide abnormalities and hospital mortality, adjusting for confounders. Results Among 9186 OHCA included in the analysis, hospital mortality was 67.3%. Hyperoxemia, hypoxemia, hypercarbia, and hypocarbia occurred in 26.5%, 19.0%, 51.0% and 30.6%, respectively. Initial hyperoxemia only was not associated with hospital mortality (adjusted OR 1.10; 95% CI: 0.97–1.26). However, final and any hyperoxemia (1.25; 1.11–1.41) were associated with increased hospital mortality. Initial (1.58; 1.30–1.92), final (3.06; 2.42–3.86) and any (1.76; 1.54–2.02) hypoxemia (PaO2 < 60 mmHg) were associated with increased hospital mortality. Initial (1.89; 1.70–2.10); final (2.57; 2.18–3.04) and any (1.85; 1.67–2.05) hypercarbia (PaCO2 > 50 mmHg) were associated with increased hospital mortality. Initial (1.13; 0.90–1.41), final (1.19; 1.04–1.37) and any (1.01; 0.91–1.12) hypocarbia (PaCO2 < 30 mmHg) were not associated with hospital mortality. Conclusions In the first 24 h after ROSC, abnormal post-arrest oxygen and carbon dioxide tensions are associated with increased out of-hospital cardiac arrest mortality.

AB - Objective To determine if arterial oxygen and carbon dioxide abnormalities in the first 24 h after return of spontaneous circulation (ROSC) are associated with increased mortality in adult out-of-hospital cardiac arrest (OHCA). Methods We used data from the Resuscitation Outcomes Consortium (ROC), including adult OHCA with sustained ROSC ≥1 h after Emergency Department arrival and at least one arterial blood gas (ABG) measurement. Among ABGs measured during the first 24 h of hospitalization, we identified the presence of hyperoxemia (PaO2 ≥ 300 mmHg), hypoxemia (PaO2 < 60 mmHg), hypercarbia (PaCO2 > 50 mmHg) and hypocarbia (PaCO2 < 30 mmHg). We evaluated the associations between oxygen and carbon dioxide abnormalities and hospital mortality, adjusting for confounders. Results Among 9186 OHCA included in the analysis, hospital mortality was 67.3%. Hyperoxemia, hypoxemia, hypercarbia, and hypocarbia occurred in 26.5%, 19.0%, 51.0% and 30.6%, respectively. Initial hyperoxemia only was not associated with hospital mortality (adjusted OR 1.10; 95% CI: 0.97–1.26). However, final and any hyperoxemia (1.25; 1.11–1.41) were associated with increased hospital mortality. Initial (1.58; 1.30–1.92), final (3.06; 2.42–3.86) and any (1.76; 1.54–2.02) hypoxemia (PaO2 < 60 mmHg) were associated with increased hospital mortality. Initial (1.89; 1.70–2.10); final (2.57; 2.18–3.04) and any (1.85; 1.67–2.05) hypercarbia (PaCO2 > 50 mmHg) were associated with increased hospital mortality. Initial (1.13; 0.90–1.41), final (1.19; 1.04–1.37) and any (1.01; 0.91–1.12) hypocarbia (PaCO2 < 30 mmHg) were not associated with hospital mortality. Conclusions In the first 24 h after ROSC, abnormal post-arrest oxygen and carbon dioxide tensions are associated with increased out of-hospital cardiac arrest mortality.

KW - Cardiopulmonary arrest

KW - Hypercarbia

KW - Hyperoxemia

KW - Hypocarbia

KW - Hypoxemia

KW - Post-arrest care

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U2 - 10.1016/j.resuscitation.2017.08.244

DO - 10.1016/j.resuscitation.2017.08.244

M3 - Article

VL - 120

SP - 113

EP - 118

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

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