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

Resuscitation. 2017 Nov:120:113-118. doi: 10.1016/j.resuscitation.2017.08.244. Epub 2017 Sep 21.

Abstract

Objective: To determine if arterial oxygen and carbon dioxide abnormalities in the first 24h 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 ≥1h after Emergency Department arrival and at least one arterial blood gas (ABG) measurement. Among ABGs measured during the first 24h of hospitalization, we identified the presence of hyperoxemia (PaO2≥300mmHg), hypoxemia (PaO2<60mmHg), hypercarbia (PaCO2>50mmHg) and hypocarbia (PaCO2<30mmHg). 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<60mmHg) 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>50mmHg) 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<30mmHg) were not associated with hospital mortality.

Conclusions: In the first 24h 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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Blood Gas Analysis
  • Carbon Dioxide / blood*
  • Cardiopulmonary Resuscitation
  • Female
  • Humans
  • Hypercapnia / etiology
  • Hypercapnia / mortality
  • Hypoxia / etiology
  • Hypoxia / mortality
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / blood*
  • Out-of-Hospital Cardiac Arrest / complications
  • Out-of-Hospital Cardiac Arrest / mortality*
  • Out-of-Hospital Cardiac Arrest / therapy
  • Oxygen / blood*
  • Prospective Studies
  • Registries

Substances

  • Carbon Dioxide
  • Oxygen