Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial

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Titel: Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial
Beteiligte: Robba, Chiara; Badenes, Rafael; Battaglini, Denise; Ball, Lorenzo; Sanfilippo, Filippo; Brunetti, Iole; Jakobsen, Janus Christian; Lilja, Gisela; Friberg, Hans; Wendel-Garcia, Pedro David; Young, Paul J.; Eastwood, Glenn; Chew, Michelle S.; Unden, Johan; Thomas, Matthew; Joannidis, Michael; Nichol, Alistair; Lundin, Andreas; Hollenberg, Jacob; Hammond, Naomi; Saxena, Manoj; Martin, Annborn; Solar, Miroslav; Taccone, Fabio Silvio; [...]
Erschienen: Springer Science and Business Media LLC, 2022
Erschienen in: Critical Care
Sprache: Englisch
DOI: 10.1186/s13054-022-04186-8
ISSN: 1364-8535
Schlagwörter: Critical Care and Intensive Care Medicine
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Beschreibung: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>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 (PaO<jats:sub>2</jats:sub>) 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 PaO<jats:sub>2</jats:sub> with patients’ outcome.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>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 PaO<jats:sub>2</jats:sub> < 60 mmHg and severe hyperoxemia as PaO<jats:sub>2</jats:sub> > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>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 (PaO<jats:sub>2</jats:sub>-AUC), for hyperoxemia was significantly associated with mortality (<jats:italic>p</jats:italic> = 0.003).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> <jats:p><jats:italic>Trial registration</jats:italic>: clinicaltrials.gov <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT02908308">NCT02908308</jats:ext-link>, Registered September 20, 2016.</jats:p> </jats:sec>
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