Arterial Blood Gas Tensions After Resuscitation From Out-of-Hospital Cardiac Arrest

Vaahersalo, Jukka; Bendel, Stepani; Reinikainen, Matti; Kurola, Jouni; Tiainen, Marjaana; Raj, Rahul; Pettilä, Ville; Varpula, Tero; Skrifvars, Markus B.

doi:10.1097/ccm.0000000000000228

Cited by 154 publications

(141 citation statements)

References 34 publications

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“…13,16,18,21,37 In our study, lower PaO2 values and higher oxygen needs established in terms of PaO 2 /FiO 2 rates, were found in patients with poor neurological long-term outcome, in accordance to results previously published by Vaahersalo in an adult population. 38 In contrast to their findings, carbon dioxide values were not found to influence neurologic longterm outcome in our patients, but if any, PCO 2 higher than 50 mmHg both at 1 h and 24 h after ROSC, showed a trend towards worsening neurological outcome rather than favoring it, which was observed too by Roberts et al 39 Hyperoxia was not found to be associated with a poorer neurological outcome.…”

Section: Post-resuscitation Variablescontrasting

confidence: 75%

Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study

et al. 2015

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Section: Post-resuscitation Variablescontrasting

confidence: 75%

Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study

et al. 2015

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“…One study 187 with a total of 850 patients showed no difference in outcome for patients ventilated to hypercapnia (Paco 2 greater than 6.0 kPa). One study 178 with a total of 409 patients showed better outcome for patients ventilated to hypercapnia (Paco 2 5.1-10.1 kPa).…”

Section: Hypercapniamentioning

confidence: 99%

“…For the critical outcome of survival to 12 months with favorable neurologic outcome (CPC 1 or 2), 1 study 178 of verylow-quality evidence (downgraded for very serious risk of bias and indirectness) showed no harmful effect associated with hyperoxia during the first 24 hours of ICU care.…”

Section: Hyperoxia Versus Normoxiamentioning

confidence: 99%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

554

125

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Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

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“…Over recent years, this dogma has started to be questioned in light of emerging, though somewhat equivocal, evidence from both animal models [2] and retrospective analyses of cardiac arrest registries [3] which suggest an association between the degree and cumulative exposure to hyperoxia, and both short-term mortality and worse neurological outcomes in survivors. Crucially, hyperoxia is frequently accompanied by hyperventilation with consequent and injurious, hypocapnia [4,5]. Thus, there is biological plausibility for the concept that cardiac arrest and current resuscitation practice subjects patients to a two-hit injury model made worse by hyperoxia (Table 1).…”

mentioning

confidence: 99%

“…Data regarding well-established factors that affect the outcome variables chosen are not presented. These include: pre-arrest co-morbidities [8]; the cause of the cardiac arrest (specifically cardiogenic verses noncardiogenic, though initial cardiac rhythm is accounted for and can be considered as a surrogate for this variable); the time from cardiac arrest to first effective CPR and the duration of CPR (time from arrest to RoSC) [9,10]; the cumulative dose of epinephrine (higher cumulative doses are associated with worse neurological outcome [11]); arterial carbon dioxide data [4,5]; and the proportion of patients who underwent emergency coronary angiography, with or without intervention [12].…”

mentioning

confidence: 99%