Hyperoxia, hypocapnia and hypercapnia as outcome factors after cardiac arrest in children.
ABSTRACT PURPOSE: Arterial hyperoxia after resuscitation has been associated with increased mortality in adults. The aim of this study was to test the hypothesis that post-resuscitation hyperoxia and hypocapnia are associated with increased mortality after resuscitation in pediatric patients. METHODS: We performed a prospective observational multicenter hospital-based study including 223 children aged between 1 month and 18 years who achieved return of spontaneous circulation after in-hospital cardiac arrest and for whom arterial blood gas analysis data were available. RESULTS: After return of spontaneous circulation, 8.5% of patients had hyperoxia (defined as PaO(2)>300mmHg) and 26.5% hypoxia (defined as PaO(2)<60mmHg). No statistical differences in mortality were observed when patients with hyperoxia (52.6%), hypoxia (42.4%), or normoxia (40.7%) (p=0.61). Hypocapnia (defined as PaCO(2)<30mmHg) was observed in 13.5% of patients and hypercapnia (defined as PaCO(2)>50mmHg) in 27.6%. Patients with hypercapnia or hypocapnia had significantly higher mortality (59.0% and 50.0%, respectively) than patients with normocapnia (33.1%) (p=0.002). At 24h after return of spontaneous circulation, neither PaO(2) nor PaCO(2) values were associated with mortality. Multiple logistic regression analysis showed that hypercapnia (OR, 3.27; 95% CI, 1.62-6.61; p=0.001) and hypocapnia (OR, 2.71; 95% CI, 1.04-7.05; p=0.04) after return of spontaneous circulation were significant mortality factors. CONCLUSIONS: In children resuscitated from cardiac arrest, hyperoxemia after return of spontaneous circulation or 24h later was not associated with mortality. On the other hand, hypercapnia and hypocapnia were associated with higher mortality than normocapnia.
- SourceAvailable from: Leonello Avalli[Show abstract] [Hide abstract]
ABSTRACT: Before the introduction of the new international cardiac arrest treatment guidelines in 2005, patients with out-of-hospital cardiac arrest (OHCA) of cardiac origin in Northern Italy had very poor prognosis. Since 2006, a new bundle of care comprising use of automated external defibrillatiors (AEDs) and therapeutic hypothermia (TH) was started, while extracorporeal CPR program (ECPR) for selected refractory CA and dispatcher-assisted cardio-pulmonary resuscitation (CPR) was started in January 2010.Resuscitation 06/2014; 85(9). · 3.96 Impact Factor
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ABSTRACT: To describe the impact of oxygen and carbon dioxide management on patient outcomes following cardiac arrest. Although there are no data that suggest that supplemental oxygen administration during cardiopulmonary resuscitation is harmful, there is concern that 100% oxygen during the postresuscitation phase may be undesirable. The evidence to avoid hyperoxia is limited to animal studies and retrospective clinical studies that examine the association between exposure and outcome. There is a correlation between end-tidal carbon dioxide values during cardiopulmonary resuscitation and resuscitation outcome, yet this correlation is likely to reflect low or absent cardiac output and be a biomarker of illness severity rather than a mediator of injury. Additionally, very limited high-level human data exist on the relationship between arterial carbon dioxide tension and outcome following cardiac arrest. Retrospective studies have identified hypocapnia in the intensive care unit as being independently associated with worse neurological and mortality outcomes in cardiac arrest patients. Although there appears to be sufficient evidence to recommend avoiding hypocapnia after resuscitation, observational data suggest that hypercapnia may be independently associated with a greater likelihood of discharge home amongst cardiac arrest survivors. Current data for oxygen and carbon dioxide management following resuscitation suggest that hyperoxia and hypocapnia may be injurious and should be avoided, and that mild hypercapnia may increase the likelihood of discharge home amongst survivors. Such data should be viewed as hypothesis generating. Randomized controlled trials have commenced to clarify the safety, feasibility and efficacy of targeting different oxygen and carbon dioxide tensions following cardiac arrest.Current opinion in critical care 04/2014; · 3.18 Impact Factor
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ABSTRACT: Post-cardiac arrest hypocapnia/hypercapnia have been associated with poor neurological outcome. However, the impact of arterial carbon dioxide (CO2) derangements during the immediate post-resuscitation period following cardiac arrest remains uncertain. We sought to test the correlation between prescribed minute ventilation and post-resuscitation partial pressure of CO2 (PaCO2), and to test the association between early PaCO2 and neurological outcome. We retrospectively analyzed a prospectively compiled single-center cardiac arrest registry. We included adult (age >= 18 years) patients who experienced a non-traumatic cardiac arrest and required mechanical ventilation. We analyzed initial post-resuscitation ventilator settings and initial arterial blood gas analysis (ABG) after initiation of post-resuscitation ventilator settings. We calculated prescribed minute ventilation:MVmL/kg/min=tidalvolumeTV/idealbodyweightIBWxrespiratoryrateRRfor each patient. We then used Pearson's correlation to test the correlations between prescribed MV and PaCO2. We also determined whether patients had normocapnia (PaCO2 between 30 and 50 mmHg) on initial ABG and tested the association between normocapnia and good neurological function (Cerebral Performance Category 1 or 2) at hospital discharge using logistic regression analyses. Seventy-five patients were included. The majority of patients were in-hospital arrests (85%). Pulseless electrical activity/asystole was the initial rhythm in 75% of patients. The median (IQR) TV, RR, and MV were 7 (7 to 8) mL/kg, 14 (14 to 16) breaths/minute, and 106 (91 to 125) mL/kg/min, respectively. Hypocapnia, normocapnia, and hypercapnia were found in 15%, 62%, and 23% of patients, respectively. Good neurological function occurred in 32% of all patients, and 18%, 43%, and 12% of patients with hypocapnia, normocapnia, and hypercapnia respectively. We found prescribed MV had only a weak correlation with initial PaCO2, R = -0.40 (P < 0.001). Normocapnia was associated with good neurological function, odds ratio 4.44 (95%CI 1.33 to 14.85). We found initial prescribed MV had only a weak correlation with subsequent PaCO2 and that early Normocapnia was associated with good neurological outcome. These data provide rationale for future research to determine the impact of PaCO2 management during mechanical ventilation in post-cardiac arrest patients.Annals of intensive care. 03/2014; 4(1):9.