Conservative or liberal oxygen therapy in adults after cardiac arrest: An individual-level patient data meta-analysis of randomised controlled trials

Paul J. Young, Michael Bailey, Rinaldo Bellomo, Stephen Bernard, Janet Bray, Pekka Jakkula, Markku Kuisma, Diane Mackle, Daniel Martin, Jerry P. Nolan, Rakshit Panwar, Matti Reinikainen, Markus B. Skrifvars, Matt Thomas

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Abstract

Aim: The effect of conservative versus liberal oxygen therapy on mortality rates in post cardiac arrest patients is uncertain. Methods: We undertook an individual patient data meta-analysis of patients randomised in clinical trials to conservative or liberal oxygen therapy after a cardiac arrest. The primary end point was mortality at last follow-up. Results: Individual level patient data were obtained from seven randomised clinical trials with a total of 429 trial participants included. Four trials enrolled patients in the pre-hospital period. Of these, two provided protocol-directed oxygen therapy for 60 min, one provided it until the patient was handed over to the emergency department staff, and one provided it for a total of 72 h or until the patient was extubated. Three trials enrolled patients after intensive care unit (ICU) admission and generally continued protocolised oxygen therapy for a longer period, often until ICU discharge. A total of 90 of 221 patients (40.7%) assigned to conservative oxygen therapy and 103 of 206 patients (50%) assigned to liberal oxygen therapy had died by this last point of follow-up; absolute difference; odds ratio (OR) adjusted for study only; 0.67; 95% CI 0.45 to 0.99; P = 0.045; adjusted OR, 0.58; 95% CI 0.35 to 0.96; P = 0.04. Conclusion: Conservative oxygen therapy was associated with a statistically significant reduction in mortality at last follow-up compared to liberal oxygen therapy but the certainty of available evidence was low or very low due to bias, imprecision, and indirectness. PROSPERO registration number: CRD42019138931.

Original languageEnglish
Pages (from-to)15-22
Number of pages8
JournalResuscitation
Volume157
DOIs
Publication statusPublished - 1 Dec 2020

Keywords

  • Cardiac arrest
  • Hyperoxaemia
  • Hypoxaemia
  • Hypoxic ischaemic encephalopathy
  • Individual patient data meta-analysis
  • Oxygen therapy
  • Randomised controlled trial

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