HyperOxic Therapy OR NormOxic Therapy after out-of-hospital cardiac arrest (HOT OR NOT): a randomised controlled feasibility trial

Paul Jeffrey Young, Mark J Bailey, Rinaldo Bellomo, Stephen Anthony Bernard, Bridget Dicker, Ross C Freebairn, Seton J Henderson, Diane Mackle, Colin McArthur, Shay P McGuinness, Tony N Smith, Mark W Weatherall, Richard W Beasley

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Aims To investigate the feasibility of delivering titrated oxygen therapy to adults with return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) caused by ventricular fibrillation (VF) or ventricular tachycardia (VT). Methods We used a multicentre, randomised, single blind, parallel groups design to compare titrated and standard oxygen therapy in adults resuscitated from VF/VT OHCA. The intervention commenced in the community following ROSC and was maintained in the emergency department and the Intensive Care Unit. The primary end point was the median oxygen saturation by pulse oximetry (SpO2) in the pre-hospital period. Results 159 OHCA patients were screened and 18 were randomised. 17 participants were analysed: nine in the standard care group and eight in the titrated oxygen group. In the pre-hospital period, SpO2 measurements were lower in the titrated oxygen therapy group than the standard care group (difference in medians 11.3 ; 95 CI 1.0?20.5 ). Low measured oxygen saturation (SpO2 <88 ) occurred in 7/8 of patients in the titrated oxygen group and 3/9 of patients in the standard care group (P = 0.05). Following hospital admission, good separation of oxygen exposure between the groups was achieved without a significant increase in hypoxia events. The trial was terminated because accumulated data led the Data Safety Monitoring Board and Management Committee to conclude that safe delivery of titrated oxygen therapy in the pre-hospital period was not feasible. Conclusions Titration of oxygen in the pre-hospital period following OHCA was not feasible; it may be feasible to titrate oxygen safely after arrival in hospital.
Original languageEnglish
Pages (from-to)1686 - 1691
Number of pages6
JournalResuscitation
Volume85
Issue number12
DOIs
Publication statusPublished - 2014

Cite this

Young, Paul Jeffrey ; Bailey, Mark J ; Bellomo, Rinaldo ; Bernard, Stephen Anthony ; Dicker, Bridget ; Freebairn, Ross C ; Henderson, Seton J ; Mackle, Diane ; McArthur, Colin ; McGuinness, Shay P ; Smith, Tony N ; Weatherall, Mark W ; Beasley, Richard W. / HyperOxic Therapy OR NormOxic Therapy after out-of-hospital cardiac arrest (HOT OR NOT): a randomised controlled feasibility trial. In: Resuscitation. 2014 ; Vol. 85, No. 12. pp. 1686 - 1691.
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title = "HyperOxic Therapy OR NormOxic Therapy after out-of-hospital cardiac arrest (HOT OR NOT): a randomised controlled feasibility trial",
abstract = "Aims To investigate the feasibility of delivering titrated oxygen therapy to adults with return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) caused by ventricular fibrillation (VF) or ventricular tachycardia (VT). Methods We used a multicentre, randomised, single blind, parallel groups design to compare titrated and standard oxygen therapy in adults resuscitated from VF/VT OHCA. The intervention commenced in the community following ROSC and was maintained in the emergency department and the Intensive Care Unit. The primary end point was the median oxygen saturation by pulse oximetry (SpO2) in the pre-hospital period. Results 159 OHCA patients were screened and 18 were randomised. 17 participants were analysed: nine in the standard care group and eight in the titrated oxygen group. In the pre-hospital period, SpO2 measurements were lower in the titrated oxygen therapy group than the standard care group (difference in medians 11.3 ; 95 CI 1.0?20.5 ). Low measured oxygen saturation (SpO2 <88 ) occurred in 7/8 of patients in the titrated oxygen group and 3/9 of patients in the standard care group (P = 0.05). Following hospital admission, good separation of oxygen exposure between the groups was achieved without a significant increase in hypoxia events. The trial was terminated because accumulated data led the Data Safety Monitoring Board and Management Committee to conclude that safe delivery of titrated oxygen therapy in the pre-hospital period was not feasible. Conclusions Titration of oxygen in the pre-hospital period following OHCA was not feasible; it may be feasible to titrate oxygen safely after arrival in hospital.",
author = "Young, {Paul Jeffrey} and Bailey, {Mark J} and Rinaldo Bellomo and Bernard, {Stephen Anthony} and Bridget Dicker and Freebairn, {Ross C} and Henderson, {Seton J} and Diane Mackle and Colin McArthur and McGuinness, {Shay P} and Smith, {Tony N} and Weatherall, {Mark W} and Beasley, {Richard W}",
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language = "English",
volume = "85",
pages = "1686 -- 1691",
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HyperOxic Therapy OR NormOxic Therapy after out-of-hospital cardiac arrest (HOT OR NOT): a randomised controlled feasibility trial. / Young, Paul Jeffrey; Bailey, Mark J; Bellomo, Rinaldo; Bernard, Stephen Anthony; Dicker, Bridget; Freebairn, Ross C; Henderson, Seton J; Mackle, Diane; McArthur, Colin; McGuinness, Shay P; Smith, Tony N; Weatherall, Mark W; Beasley, Richard W.

In: Resuscitation, Vol. 85, No. 12, 2014, p. 1686 - 1691.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Young, Paul Jeffrey

AU - Bailey, Mark J

AU - Bellomo, Rinaldo

AU - Bernard, Stephen Anthony

AU - Dicker, Bridget

AU - Freebairn, Ross C

AU - Henderson, Seton J

AU - Mackle, Diane

AU - McArthur, Colin

AU - McGuinness, Shay P

AU - Smith, Tony N

AU - Weatherall, Mark W

AU - Beasley, Richard W

PY - 2014

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N2 - Aims To investigate the feasibility of delivering titrated oxygen therapy to adults with return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) caused by ventricular fibrillation (VF) or ventricular tachycardia (VT). Methods We used a multicentre, randomised, single blind, parallel groups design to compare titrated and standard oxygen therapy in adults resuscitated from VF/VT OHCA. The intervention commenced in the community following ROSC and was maintained in the emergency department and the Intensive Care Unit. The primary end point was the median oxygen saturation by pulse oximetry (SpO2) in the pre-hospital period. Results 159 OHCA patients were screened and 18 were randomised. 17 participants were analysed: nine in the standard care group and eight in the titrated oxygen group. In the pre-hospital period, SpO2 measurements were lower in the titrated oxygen therapy group than the standard care group (difference in medians 11.3 ; 95 CI 1.0?20.5 ). Low measured oxygen saturation (SpO2 <88 ) occurred in 7/8 of patients in the titrated oxygen group and 3/9 of patients in the standard care group (P = 0.05). Following hospital admission, good separation of oxygen exposure between the groups was achieved without a significant increase in hypoxia events. The trial was terminated because accumulated data led the Data Safety Monitoring Board and Management Committee to conclude that safe delivery of titrated oxygen therapy in the pre-hospital period was not feasible. Conclusions Titration of oxygen in the pre-hospital period following OHCA was not feasible; it may be feasible to titrate oxygen safely after arrival in hospital.

AB - Aims To investigate the feasibility of delivering titrated oxygen therapy to adults with return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) caused by ventricular fibrillation (VF) or ventricular tachycardia (VT). Methods We used a multicentre, randomised, single blind, parallel groups design to compare titrated and standard oxygen therapy in adults resuscitated from VF/VT OHCA. The intervention commenced in the community following ROSC and was maintained in the emergency department and the Intensive Care Unit. The primary end point was the median oxygen saturation by pulse oximetry (SpO2) in the pre-hospital period. Results 159 OHCA patients were screened and 18 were randomised. 17 participants were analysed: nine in the standard care group and eight in the titrated oxygen group. In the pre-hospital period, SpO2 measurements were lower in the titrated oxygen therapy group than the standard care group (difference in medians 11.3 ; 95 CI 1.0?20.5 ). Low measured oxygen saturation (SpO2 <88 ) occurred in 7/8 of patients in the titrated oxygen group and 3/9 of patients in the standard care group (P = 0.05). Following hospital admission, good separation of oxygen exposure between the groups was achieved without a significant increase in hypoxia events. The trial was terminated because accumulated data led the Data Safety Monitoring Board and Management Committee to conclude that safe delivery of titrated oxygen therapy in the pre-hospital period was not feasible. Conclusions Titration of oxygen in the pre-hospital period following OHCA was not feasible; it may be feasible to titrate oxygen safely after arrival in hospital.

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