Abstract
Background: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients’ outcome. Methods: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). Conclusions: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration: clinicaltrials.gov NCT02908308, Registered September 20, 2016.
| Original language | English |
|---|---|
| Article number | 323 |
| Number of pages | 13 |
| Journal | Critical Care |
| Volume | 26 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 21 Oct 2022 |
Keywords
- Cardiac arrest
- Hyperoxemia
- Hypoxemia
- Mortality
- Neurological outcome
Cite this
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver
}
In: Critical Care, Vol. 26, No. 1, 323, 21.10.2022.
Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Oxygen targets and 6-month outcome after out of hospital cardiac arrest
T2 - a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial
AU - Robba, Chiara
AU - Badenes, Rafael
AU - Battaglini, Denise
AU - Ball, Lorenzo
AU - Sanfilippo, Filippo
AU - Brunetti, Iole
AU - Jakobsen, Janus Christian
AU - Lilja, Gisela
AU - Friberg, Hans
AU - Wendel-Garcia, Pedro David
AU - Young, Paul J.
AU - Eastwood, Glenn
AU - Chew, Michelle S.
AU - Unden, Johan
AU - Thomas, Matthew
AU - Joannidis, Michael
AU - Nichol, Alistair
AU - Lundin, Andreas
AU - Hollenberg, Jacob
AU - Hammond, Naomi
AU - Saxena, Manoj
AU - Martin, Annborn
AU - Solar, Miroslav
AU - Taccone, Fabio Silvio
AU - Dankiewicz, Josef
AU - Nielsen, Niklas
AU - Grejs, Anders
AU - Ebner, Florian
AU - Pelosi, Paolo
AU - Bělohlávek, Jan
AU - Callaway, Clifton
AU - Cariou, Alain
AU - Cronberg, Tobias
AU - Erlinge, David
AU - Hovdenes, Jan
AU - Kirkegaard, Hans
AU - Levin, Helena
AU - Morgan, Matt P.G.
AU - Nordberg, Per
AU - Oddo, Mauro
AU - Rylander, Christian
AU - Storm, Christian
AU - Ullén, Susann
AU - Wise, Matt P.
AU - Rowan, Kathy
AU - Harrison, David
AU - Mouncey, Paul
AU - Shankar-Hari, Manu
AU - Young, Duncan
AU - Lange, Theis
AU - Palmér, Karolina
AU - Karlsson, Ulla Britt
AU - Heissler, Simon
AU - Bass, Frances
AU - Myburgh, John
AU - Taylor, Colman
AU - Bellino, Adele
AU - Abel-all, Marwa
AU - Finfer, Ben
AU - Koch, Carolyn
AU - Li, Yang
AU - O’Connor, Anne
AU - Pilowsky, Julia
AU - Schneider, Tina
AU - Tippett, Anna
AU - Ady, Bridget
AU - Broadley, Tessa
AU - Brown, Amanda
AU - Melgaard, Liz
AU - Morgan, Mimi
AU - Singh, Vanessa
AU - Symons, Rebecca
AU - Becker, Kathrin
AU - Sante, Nathalie
AU - Saleova, Vendula
AU - Zerzanova, Silvie
AU - Sefir-Kribel, Samia
AU - Lübeck, Ute
AU - Carrara, Martina
AU - Fernando, Kathryn
AU - Mackle, Diane
AU - Navarra, Leanlove
AU - Riley, Judith
AU - Westerheim, Elin
AU - Flatebø, Marianne
AU - Ceric, Ameldina
AU - Haxhija, Zana
AU - Terling, Lovisa
AU - Bossmar, Lena
AU - Jergle, Liz
AU - Månsson, Helén Holm
AU - Maillard, Samia Abed
AU - Zagar, Andreja Vujicic
AU - Jodlauk, Christina
AU - Scrivens, Jennifer
AU - Ainscough, Kate
AU - Fahey, Ciara
AU - Bellomo, Rinaldo
AU - Peck, Leah
AU - Young, Helen
AU - Cheung, Winston
AU - Cross, Rosalba
AU - Hayes, Michael
AU - Jain, Nitin
AU - Kol, Mark
AU - Shah, Asim
AU - Wagh, Atul
AU - Wong, Helen
AU - Eduardo Martinez, F.
AU - Brinkerhoff, Gail
AU - Bush, Dustin
AU - Stewart, Antony
AU - Aneman, Anders
AU - Lombardo, Lien
AU - McCanny, Peter
AU - Penketh, James
AU - Seppelt, Ian
AU - Gresham, Rebecca
AU - Lowrey, Julie
AU - Masters, Kristy
AU - Whitehead, Christina
AU - Walsham, James
AU - Harward, Meg
AU - Mackay, Josephine
AU - Meyer, Jason
AU - Saylor, Emma
AU - Venz, Ellen
AU - Wetzig, Krista
AU - Stedman, Wade
AU - Ashelford, Angela
AU - Mar, Sharon
AU - Tokumitsu, Miyuki
AU - Yarad, Elizabeth
AU - Buscher, Hergen
AU - Reynolds, Claire
AU - Udy, Andrew
AU - Burrell, Aidan
AU - Collins, Jasmin
AU - Gantner, Dashiell
AU - Martin, Victoria Emma Leah
AU - Mccracken, Phoebe
AU - Nanjayya, Vinodh
AU - Richardson, Alexander Sacha
AU - Young, Meredith
AU - Ghosh, Angaj
AU - Said, Simone
AU - Beer, Ronny
AU - Hartig, Frank
AU - Helbok, Raimund
AU - Klein, Sebastian
AU - Peer, Andreas
AU - Creteur, Jacques
AU - Durand, Dominique
AU - Dupont, Matthias
AU - Christiaens, Sigrid
AU - Claes, Carola
AU - Deckx, Sebastiaan
AU - Ferdinande, Bert
AU - Lenaerts, Sanne
AU - Mullens, Wilifred
AU - Stroobants, Sarah
AU - Theunissen, Evi
AU - Verhaert, David
AU - Šmíd, Ondřej
AU - Flaksa, Marek
AU - Kemlink, David
AU - Malík, Jan
AU - Otáhal, Michal
AU - Rulíšek, Jan
AU - Šíranec, Michal
AU - Stach, Zdeněk
AU - Valeriánová, Anna
AU - Zavadilova, Petra
AU - Solař, Miroslav
AU - Bánszky, Róber
AU - Červená, Jana
AU - Pařízková, Renata Černá
AU - Šimůnek, Libor
AU - Varhaník, Filip
AU - Karásek, Jiří
AU - Strýček, Matěj
AU - Grejs, Anders
AU - Christensen, Steffen
AU - Juhl-Olsen, Peter
AU - Thomsen, Ida Katrine
AU - Østergaard, Lisa Gregersen
AU - Cao, Albert
AU - Dupland, Pierre
AU - Gavaud, Ariane
AU - Jaubert, Paul
AU - Jozwiak, Mathieu
AU - Marin, Nathalie
AU - Savary, Guillaume
AU - Deye, Nicolas
AU - Megarbane, Bruno
AU - Mora, Pierre
AU - Sutterlin, Laetitia
AU - Legriel, Stephane
AU - Bellut, Hugo
AU - Ferre, Alexis
AU - Lacave, Guillaume
AU - Paul, Marine
AU - Lascarrou, Jean Baptiste
AU - Canet, Emmanuel
AU - Garret, Charlotte
AU - Miaihle, Arnaud Felix
AU - Reignier, Jean
AU - Vignon, Philippe
AU - Daix, Thomas
AU - Desachy, Arnaud
AU - Evrard, Bruno
AU - Francois, Bruno
AU - Fedou, Anne Laure
AU - Goudelin, Marine
AU - Leithner, Christoph
AU - Nee, Jens
AU - Streitberger, Kaspar Josche
AU - Bonatti, Giulia
AU - Firpo, Iacopo
AU - Frisoni, Paolo
AU - Iachi, Arianna
AU - Maiani, Simona
AU - Mandelli, Maura
AU - Tarantino, Fabio
AU - Barbieri, Alberto
AU - Bertellini, Elisabetta
AU - Giuliani, Enrico
AU - Melegari, Gabriele
AU - Roman-Pognuz, Erik
AU - Berlot, Giorgio
AU - Lucangelo, Umberto
AU - Macchini, Elisabetta
AU - Aune, Vibeke
AU - Drægni, Tomas
AU - Jacobsen, Simon
AU - Pieschke, Søren
AU - Rasmussen, Åse
AU - Akselsen, Gro Ringstad
AU - Langeland, Halvor
AU - Bergum, Daniel
AU - Erbe, Therese M.
AU - Klepstad, Pål
AU - Næss, Helle M.
AU - Olsen, Roy Bjørkholt
AU - Skjelnes, Lena Eriksen
AU - Holen, Marius
AU - Post, Joakim Iver
AU - Fanebust, Rune
AU - Sørensen, Linda Hårteig
AU - Kårstad, Ken Åge
AU - TTM2 Trial collaborators
N1 - Funding Information: We would like to thank Prof Eduardo Nunez for the support with the statistical analysis. TTM2 Trial collaborators STEERING GROUP Niklas Nielsen, Jan Bělohlávek, Clifton Callaway, Alain Cariou, Tobias Cronberg, Josef Dankiewicz, Glenn Eastwood, David Erlinge, Hans Friberg, Jan Hovdenes, Janus Christian Jakobsen, Michael Joannidis, Hans Kirkegaard, Helena Levin, Gisela Lilja, Matt P. G. Morgan, Alistair D. Nichol, Per Nordberg, Mauro Oddo, Paolo Pelosi, Christian Rylander, Manoj Saxena, Christian Storm, Fabio S. Taccone, Susann Ullén, Matt P. Wise, Paul J. Young INDEPENDENT DATA MONITORING AND SAFETY COMMITTEE Kathy Rowan, David Harrison, Paul Mouncey, Manu Shankar-Hari, Duncan Young STATISTICIANS Susann Ullén, Theis Lange, Karolina Palmér COORDINATING ORGANIZATIONS AND TRIAL MANAGEMENT Core management group: Niklas Nielsen, Josef Dankiewicz, Tobias Cronberg, Hans Friberg, Gisela Lilja, Helena Levin Clinical Trial Manager: Janus Christian Jakobsen, Susann Ullén Trial financial management: Ulla-Britt Karlsson, Simon Heissler Manoj Saxena, Frances Bass, Naomi Hammond, John Myburgh, Colman Taylor Alain Cariou, Adele Bellino TRIAL COORDINATORS AND MONITORS Marwa Abel-all, Ben Finfer, Carolyn Koch, Yang Li, Anne O’Connor, Julia Pilowsky, Tina Schneider, Anna Tippett, Bridget Ady, Tessa Broadley, Amanda Brown, Liz Melgaard, Mimi Morgan, Vanessa Singh, Rebecca Symons, Kathrin Becker, Nathalie Van Sante, Vendula Saleova, Silvie Zerzanova, Helena Levin. France: Clinical Research Unit, Paris Descartes Necker Cochin, Paris: Samia Sefir-Kribel. Germany: Charité Universitätsmedizin, Berlin: Ute Lübeck. Italy: Mario Negri Institute for Pharmacological Research, Milan: Martina Carrara. New Zealand: Medical Research Institute of New Zealand (MRINZ), Wellington: Kathryn Fernando, Diane Mackle, Leanlove Navarra, Judith Riley. Norway: Oslo University Hospital, Oslo: Elin Westerheim; Haukeland University Hospital, Bergen: Marianne Flatebø. Sweden: Helsingborg Hospital, Helsingborg: Ameldina Ceric, Zana Haxhija, Lovisa Terling; Skåne University Hospital, Lund: Lena Bossmar, Liz Jergle, Helén Holm Månsson. Switzerland: Lausanne University Hospital (CHUV), Lausanne: Samia Abed Maillard, Andreja Vujicic Zagar; Cantonal Hospital St. Gallen, St. Gallen: Christina Jodlauk. United Kingdom: University Hospital of Wales, Cardiff: Helen Hill; Niche Science & Technology, Richmond: Jennifer Scrivens; The HRB Irish Critical Care- Clinical Trials Network (ICC-CTN), Dublin, Ireland: Kate Ainscough, Ciara Fahey. SITES, PRINCIPAL INVESTIGATORS, AND SITE PERSONNEL Australia: Austin Hospital, Melbourne: Rinaldo Bellomo (PI), Glenn Eastwood, Leah Peck, Helen Young; Concord Repatriation General Hospital, Sydney: Winston Cheung (PI), Rosalba Cross, Michael Hayes, Nitin Jain, Mark Kol, Asim Shah, Atul Wagh, Helen Wong; John Hunter Hospital, Newcastle: F. Eduardo Martinez (PI), Gail Brinkerhoff, Dustin Bush; Liverpool Hospital, Sydney: Antony Stewart (PI), Anders Aneman, Lien Lombardo, Peter McCanny, James Penketh; Nepean Hospital, Sydney: Ian Seppelt (PI), Rebecca Gresham, Julie Lowrey, Kristy Masters, Christina Whitehead; Princess Alexandra Hospital, Brisbane: James Walsham (PI), Meg Harward, Josephine Mackay, Jason Meyer, Emma Saylor, Ellen Venz, Krista Wetzig; Royal North Shore Hospital, Sydney: Wade Stedman (PI), Angela Ashelford, Frances Bass, Naomi Hammond, Sharon Mar, Julia Pilowsky, Miyuki Tokumitsu, Elizabeth Yarad; St Vincent's Hospital, Sydney: Hergen Buscher (PI), Claire Reynolds; The Alfred Hospital, Melbourne: Andrew Udy (PI), Aidan Burrell, Jasmin Collins, Dashiell Gantner, Victoria Emma-Leah Martin, Phoebe Mccracken, Vinodh Nanjayya, AlistairNichol, Alexander Sacha Richardson, Meredith Young; The Northern Hospital, Melbourne: Angaj Ghosh (PI), Simone Said. Austria: Medical University Innsbruck, Innsbruck: Michael Joannidis (PI), Ronny Beer, Frank Hartig, Raimund Helbok, Sebastian Klein, Andreas Peer. Belgium: Erasme University Hospital, Brussels: Fabio S. Taccone (PI), Jacques Creteur, Dominique Durand; Ziekenhuis Oost-Limburg, Genk: Matthias Dupont (PI), Sigrid Christiaens, Carola Claes, Sebastiaan Deckx, Bert Ferdinande, Sanne Lenaerts, Wilifred Mullens, Sarah Stroobants, Evi Theunissen, David Verhaert. Czech Republic: General University Hospital, Prague: Ondřej Šmíd (PI), Marek Flaksa, David Kemlink, Jan Malík, Michal Otáhal, Jan Rulíšek, Michal Šíranec, Zdeněk Stach, Anna Valeriánová, Petra Zavadilova; University Hospital Hradec Králové, Hradec Králové: Miroslav Solař (PI), Róber Bánszky, Jana Červená, Renata Černá Pařízková, Libor Šimůnek, Filip Varhaník; Regional Hospital Liberec, Liberec: Jiří Karásek (PI), Matěj Strýček. Denmark: Aarhus University Hospital, Aarhus: Anders Grejs (PI), Steffen Christensen, Peter Juhl-Olsen, Ida Katrine Thomsen, Lisa Gregersen Østergaard. France: Cochin University Hospital (APHP), Paris: Alain Cariou (PI), Albert Cao, Pierre Dupland, Ariane Gavaud, Paul Jaubert, Mathieu Jozwiak, Nathalie Marin, Guillaume Savary; Lariboisiere University Hospital (APHP), Paris: Nicolas Deye (PI), Bruno Megarbane, Pierre Mora, Laetitia Sutterlin; Centre Hospitalier de Versailles, Le Chesnay: Stephane Legriel (PI), Hugo Bellut, Alexis Ferre, Guillaume Lacave, Marine Paul; CHU de Nantes, Nantes: Jean-Baptiste Lascarrou (PI), Emmanuel Canet, Charlotte Garret, Arnaud Felix Miaihle, Jean Reignier; Dupuytren Teaching Hospital, Limoges: Philippe Vignon (PI), Thomas Daix, Arnaud Desachy, Bruno Evrard, Bruno Francois, Anne-Laure Fedou, Marine Goudelin. Germany: Charité Universitätsmedizin, Berlin: Christian Storm (PI), Gabriele Kress, Christoph Leithner, Jens Nee, Kaspar Josche Streitberger. Italy: San Martino Policlinico Hospital, Genoa: Iole Brunetti (PI), Lorenzo Ball, Denise Battaglini, Giulia Bonatti, Iacopo Firpo, Paolo Frisoni, Arianna Iachi, Simona Maiani, Maura Mandelli, Chiara Robba, Fabio Tarantino; Civil Hospital, Baggiovara, Modena: Alberto Barbieri (PI), Elisabetta Bertellini, Enrico Giuliani, Gabriele Melegari; University of Trieste, Trieste: Erik Roman-Pognuz (PI), Giorgio Berlot, Umberto Lucangelo, Elisabetta Macchini. Norway: Oslo University Hospital, Rikshospitalet, Oslo: Jan Hovdenes (PI), Vibeke Aune, Tomas Drægni, Simon Jacobsen, Søren Pieschke, Åse Rasmussen, Gro Ringstad Akselsen; St. Olav’s University Hospital, Trondheim: Halvor Langeland (PI), Daniel Bergum, Therese M. Erbe, Pål Klepstad, Helle M. Næss; Sorlandet Hospital, Arendal: Roy Bjørkholt Olsen (PI), Lena Eriksen Skjelnes, Marius Holen, Joakim Iver Post; Haukeland University Hospital, Bergen: Rune Fanebust (PI), Linda Hårteig Sørensen, Ken Åge Kårstad, Carsten Fredrik Wickman. New Zealand: Wellington Regional Hospital, Wellington: Paul Young (PI), Colin Barnes, Ben Barry, Nina Beehre, Dick Dinsdale, Sam Edney, Anna Hunt, Harriet Judd, Charlotte Latimer-Bell, Cassie Lawrence, James Moore, Shaanti Olatunji, Alex Psirides, Chelsea Robinson, Kate Tietjens, Jason Wright; Christchurch Hospital, Christchurch: David Knight (PI), Brandon Birker, David Bowie, Tara Burke, David Closey, Rosalind Crombie, Neil Davidson, Seton Henderson, Louise Hitchings, James McKay, Jan Mehrtens, Emmeline Minto, Stacey Morgan, Anna Morris, Jay Ritzemar-Carter, Jessica Roberts, Geoffrey Shaw, Katherine Townend, Kymbalee Vander Heyden. Sweden: Sahlgrenska University Hospital, Gothenburg: Christian Rylander (PI), Marita Ahlqvist, Roman Desta Lindgren, Ingrid Eiving, Andreas Lundin, Patrik Martner, Elisabeth Myhrman, Birgitta Ryding; Skåne University Hospital, Malmö: Joachim Düring (PI), Mattias Bergström, Mattias Bohm, Ingrid Didriksson, Petrea Frid, Katarina Heimburg, Marina Larsson, Oscar Lundberg, Stefan Olsson Hau, Simon Schmidbauer; Skåne University Hospital, Lund: Ola Borgquist (PI), Anne Adolfsson, Anna Bjärnroos, Erik Blennow-Nordström, Irina Dragancea, Thomas Kander, Anna Lybeck, Gustav Mattiasson, Olof Persson, Malin Rundgren, Susann Schrey, Erik Westhall; Helsingborg Hospital, Helsingborg: Martin Annborn (PI), Sara Andertun, Florian Ebner, Nerida Gustavsson, Lisa Hassel, Jesper Johnsson, Marie Nelderup, Heléne Petersson, Jörgen Petersson, Frideriki Stafilidou; Hallands Hospital, Halmstad: Johan Undén (PI), Frida Antonsson, Git Bergman, Jörgen Gamroth, Maria Meirik, Katarina Rudolfsson, Helena Sandberg, Martin Thorsson; Karlstad Central Hospital, Karlstad: Kristin Savolainen (PI), Maria Hansbo, Malin Helliksson, Björne Nödtveidt, Johan Sanner, Victoria Sem, Camilla Sund Lindquist; Södersjukhuset, Karolinska Institute, Stockholm: Per Nordberg (PI), Akil Awad, Anna-Sofia Börjesson, Malin Hedberg, Mia Henning, Jacob Hollenberg; Northern Älvsborg County Hospital, Trollhättan: Per Petersen (PI), Emelia Dahlberg, Johan Forshammar, Veronica Svensson; Capio S:t Görans Hospital, Stockholm: Michael Wanecek (PI), Håkan Eskilsson; Skaraborg Hospital, Skövde: Daniel Rodriguez-Santos (PI), Åsa Appelqvist, Henrietta Jidbratt, Elisabeth Johansson, Lars Kiszakiewicz, Åsa Nilsson, Sinnika Olsson, Anders Paulsson, Urszula Stempel, Andreas Thoren; Örebro University Hospital, Örebro: Stefan Persson (PI), Ida Berglund, Eric Bergström, Cathrine Törnqvist, Ingela Östman; Uppsala University Hospital, Uppsala: Sten Rubertsson (PI), Ing-Marie Larsson, Elin Söderman, Ewa Wallin, Joanna Wessbergh; Linköping University Hospital, Linköping: Thomas Halliday (PI), Filippa Engvall. Switzerland: Lausanne University Hospital (CHUV), Lausanne: Mauro Oddo (PI), Nawfel Ben-Hamouda, Adriano Bernini, Pierre-Nicolas Carron, Philippe Eckert, Eva Favre, John-Paul Miroz, Paola Morelli, Olivier Muller, Jan Novi, Andrea Rosseti, Madeleine Schnorf; Bern University Hospital, Bern: Matthias Haenggi (PI), Anja Levis, Sandra Nansoz, Marianne Roth & Team, Nicole Söll; Cantonal Hospital St. Gallen, St.Gallen: Claudia Schrag (PI), Mensur Alicajic, Philipp Baier, Joel Dütschler, Dominique Flügel, Edith Fässler, Ruth Gamio-Veis, Marc Güpfert, Yvonne Hilpertshauser, Stefan Hägele-Link, Gian-Reto Kleger, Peter Krähenmann, Maria Elisabeth Mair, Nadja Schai, Christoph Strohmaier, Peter Tangl, Dominik Zieglgänsberger; University Hospital Zurich, Zurich: Marco Maggiorini (PI), Gabriele Claus, Gabi Consani-Vogel, Lukas Imbach, Samira Kaiser, Eva-Maria Kleinert, Pedro David Wendel Garcia; Cardiocentro Ticino, Lugano: Tiziano Cassina (PI), Pamela Agazzi, Bruno Capelli, Gabriele Casso, Martino Regazzi, Hervé Schlotterbeck, Gabriele Via, Michele Villa. United Kingdom: University Hospital of Wales, Cardiff: Matt P. Wise (PI), Jenny Brooks, Eve Cocks, Jade Cole, Jacqueline Curtin, Michelle Davies, Rhys Davies, Stephen Fernandez, Julie Highfield, Helen Hill, Matt P. G. Morgan, Lydia Pennant, Sofia Rose, Emma Thomas, Angharad Williams; Royal Victoria Hospital, Belfast: Peter McGuigan (PI), Stephen Haffey, Aisling O'Neill, Kathryn Ward; Bristol Royal Infirmary, Bristol: Matthew Thomas (PI), Jeremy Bewley, Anna Chillingworth, Julie Cloake, Libby Cole, Hilary Galvin, Zoe Garland, Lisa Grimmer, Bethany Gumbrill, Lucy Howie, Rebekah Johnson, Chloe Searles, Agnieszka Skorko, Katie Sweet, Victoria Taylor, Denise Webster; Essex Cardiothoracic Centre, Basildon: Thomas Keeble (PI), Gill Adams, Rajesh K Aggarwal, Jo-Anne Cartwright, Steven Church, Gerald J Clesham, John R Davies, Kelly Farrell, Reto Gamma, Jane Harding, Rohan Jagathesan, Alamgir Kabir, Paul A Kelly, Lauren Kittridge, Maria Maccaroni, Gracie Maloney, Marco Mion, Naveen Nain, Raghunath Nalgirkar, Gyanesh Namjoshi, Stacey Pepper, Emily Redman, Nicholas M Robinson, Jeremy Sayer, Amanda Solesbury, Kare H Tang, Sali Urovi, Kunal Waghmare, Noel Watson, Teresa Webber; University Hospitals Birmingham NHS Foundation Trust, Birmingham: Peter Isherwood (PI), Conor Bentley, Colin Bergin, Ronald Carrera, Amy Clark, Lauren Cooper, Liesl Despy, Natalie Dooley, Karen Ellis, Emma Fellows, Stephanie Goundry, Samantha Harkett, Christopher McGhee, Aoife Neal, Hazel Smith, Catherine Snelson, Elaine Spruce, Tony Whitehouse, Kamal Yakoub; Royal Berkshire Hospital, Reading: Andrew Walden (PI), Shauna Bartley, Parminder Bhuie, Matthew Frise, Nicola Jacques, Liza Keating; Queen Alexandra Hospital, Portsmouth: David Pogson (PI), Zoe Daly, Steve Rose; Manchester Royal Infirmary, Manchester: Jonathan Bannard-Smith (PI), Rachael Quayle; Royal Bournemouth Hospital, Bournemouth: Nigel Chee (PI), Nina Barratt, Katie Bowman, Debbie Branney, Elizabeth Howe, Maria Letts, Sally Pitts, Luke Vamplew. USA: University of Pittsburgh, Pittsburgh PA: Clifton W. Callaway (PI), Sara Difiore Sprouse, Ankur A. Doshi; Mayo Clinic, Rochester MN: Jennifer Fugate (PI), Amy M. Headlee, Eelco F.M.Wijdicks. PI—Principal Investigator RELATED ORGANIZATIONS Copenhagen Trial Unit, Copenhagen, Denmark; Clinical Studies Sweden – Forum South, Skåne University Hospital, Lund, Sweden; The George Institute for Global Health, Sydney, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Medical Research Institute of New Zealand - (MRINZ), Wellington, New Zealand; Clinical Research Unit, Paris Descartes Necker Cochin, Paris, France; Scandinavian Critical Care Trials Group (SCCTG); The HRB Irish Critical Care- Clinical Trials Network (ICC-CTN); The ANZICS Clinical Trials Group (CTG); Spiral Software, Wellington, New Zealand; Allianz Global Corporate & Specialty SE, Copenhagen, Denmark; IBBL (Integrated BioBank of Luxembourg), Dudelange, Luxembourg. Funding Information: Dr. Saxena is receiving consulting fees from Bard Medical; Dr. Young is receiving lecture fees from Bard Medical; Dr. Taccone is receiving grant support from Bard Medical and ZOLL Medical; Dr. Nichol is receiving grant support, paid to University College Dublin, from AM Pharma and grant sup-port, paid to Monash University, from Baxter Healthcare; Dr. Chew is receiving lecture fees from Edwards Lifesciences; Dr. Friberg is receiving fees for academic advising from TEQCool; and Dr. Nielsen is receiving lecture fees from Bard Medical and consulting fees from BrainCool. Dr Badenes is supported by INCLIVA. Dr Robba received fees for lectures from Masimo, and GE. Dr. Battaglini received fees for lectures from Baxter. No other potential conflict of interest relevant to this article was reported. Funding Information: The TTM2 trial was supported by independent research grants from nonprofit or governmental agencies (the Swedish Research Council [Veten-skapsrådet], Swedish Heart–Lung Foundation, Stig and Ragna Gorthon Foundation, Knutsson Foundation, Laerdal Founda-tion, Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research, and Regional Research Support in Region Skåne) and by governmental funding of clinical research within the Swedish National Health Service. No further fundings were requested for this sub-analysis. Publisher Copyright: © 2022, The Author(s).
PY - 2022/10/21
Y1 - 2022/10/21
N2 - Background: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients’ outcome. Methods: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). Conclusions: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration: clinicaltrials.gov NCT02908308, Registered September 20, 2016.
AB - Background: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients’ outcome. Methods: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). Conclusions: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration: clinicaltrials.gov NCT02908308, Registered September 20, 2016.
KW - Cardiac arrest
KW - Hyperoxemia
KW - Hypoxemia
KW - Mortality
KW - Neurological outcome
UR - https://www.scopus.com/pages/publications/85140287744
U2 - 10.1186/s13054-022-04186-8
DO - 10.1186/s13054-022-04186-8
M3 - Article
C2 - 36271410
AN - SCOPUS:85140287744
SN - 1364-8535
VL - 26
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 323
ER -