Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial)

Bray, Janet; Hein, Cindy; Smith, Karen; Stephenson, Michael; Grantham, Hugh; Finn, Judith; Stub, Dion; Cameron, Peter; Bernard, Stephen

doi:10.1016/j.resuscitation.2018.04.019

Cited by 49 publications

(40 citation statements)

References 20 publications

(12 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…More recent studies have focused on the titration of supplemental O 2 in both the prehospital and emergency department settings, with evidence suggesting that it is feasible and that oxygenation parameters in the emergency department are improved with automated titration of O 2 versus manual titration of oxygen. [45][46][47] Although these results do not pertain to the effects of hyperoxia on clinical outcomes, they are encouraging in that their methodologies may be implemented to guide future research to better assess the effects of hyperoxia in critically ill adult patients in all acute care settings.…”

Section: Discussion and Future Directionsmentioning

confidence: 99%

The Impact of Hyperoxia in the Critically Ill Patient: A Review of the Literature

2020

View full text Add to dashboard Cite

Oxygen has long been considered a vital and potentially life-saving component of emergency care. Given this, there is widespread and liberal use of supplemental oxygen in hospitals across the United States and throughout the world. Recent research, however, delineates serious deleterious effects at the cellular level, inducing damage to the cardiovascular system, the central nervous system, the pulmonary system, and beyond. A scoping review was conducted to identify and synthesize available research data as it pertains to the clinical effects of hyperoxia in critically ill adult patients in acute care settings. We searched PubMed, MEDLINE, CINAHL, and Scopus databases. We also reviewed the reference lists of included publications. The selection of relevant articles was conducted by 2 researchers at 2 levels of screening. The review identified 30 studies, of which 5 were randomized controlled trials, 2 were prospective cohort studies, and 23 were retrospective cohort studies. A descriptive analysis of study results was performed. Current evidence suggests an association between hyperoxia and increased mortality after cardiac arrest, stroke, and traumatic brain injury, as well as in the setting of sepsis, although there is insufficient evidence to conclude concretely that hyperoxia effects clinical outcomes. As such, there exists a need for additional largescale randomized controlled trials with well-defined parameters for the evaluation of clinical outcomes. Until the completion of such trials, titration of supplemental O 2 to normoxia is advised to avoid the negative effects of both hyperoxia and hypoxia in acutely ill adult patients.

show abstract

Section: Discussion and Future Directionsmentioning

confidence: 99%

The Impact of Hyperoxia in the Critically Ill Patient: A Review of the Literature

2020

View full text Add to dashboard Cite

show abstract

“…A second randomised trial conducted in Australia documented widely scattered blood oxygen saturation values that were downloaded from pulse oximeter monitors; consequently, the study was discontinued early [12]. Following the completion of our trial a further feasibility study has been published, [13] showing that a titrated oxygen strategy is possible. Arterial blood oxygen desaturations were more common in the titrated group, however the findings were used to support the case for a large randomised controlled trial.…”

Section: Discussionmentioning

confidence: 99%

Cluster randomised comparison of the effectiveness of 100% oxygen versus titrated oxygen in patients with a sustained return of spontaneous circulation following out of hospital cardiac arrest: a feasibility study. PROXY: post ROSC OXYgenation study

et al. 2019

View full text Add to dashboard Cite

BackgroundHyperoxia following out of hospital cardiac arrest (OHCA) is associated with a poor outcome. Animal data suggest the first hour post resuscitation may be the most important. In the UK the first hour usually occurs in the prehospital environment.MethodsA prospective controlled trial, cluster randomised by paramedic, comparing titrated oxygen with 100% oxygen for the first hour after return of spontaneous circulation (ROSC) following OHCA.The trial was done in a single emergency medical services (EMS) system in the United Kingdom (UK) admitting patients to three emergency departments. This was a feasibility trial to determine whether EMS staff (UK paramedics) can be successfully recruited and deliver the intervention.ResultsOne hundred and fifty seven paramedics were approached and 46 (29%) were consented, randomised and trained. During the study period 624 patients received a resuscitation attempt. A study paramedic was in attendance at 73 (12%) of these active resuscitations. Thirty-five patients were recruited to the trial, 32 (91%) were transported to hospital and 13 (37%) survived to 90 days. The intervention was initiated in 27/35 (77%) of enrolled patients. A reliable oxygen saturation trace was obtained in 22/35 (69%) of patients. Data collection was complete in 33/35 (94%) of patients.ConclusionsIt may be feasible to complete a randomised trial of titrated versus unrestricted oxygen in the first hour after ROSC following OHCA in the UK. However, the relatively few eligible patients and incomplete initiation of the allocated intervention are challenges to future research.Trial registration ISRCTN 49548506 retrospectively registered on 24.11.2016.

show abstract

“…Several RCTs have compared low-dose oxygen treatment with high-dose oxygen treatment in prehospital settings in patients after ROSC. [6][7][8][9] While oxygen treatment at a lower concentration compared to 100% oxygen treatment had no benefit for survival discharge in a cluster RCT, targeting of oxygen concentrations lower than 100% showed a benefit for survival discharge. [6][7][8] In a meta-analysis that evaluated survival discharge with good neurological outcomes, there was no benefit of supplying low concentrations of oxygen.…”

Section: Airway and Breathingmentioning

confidence: 96%

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

et al. 2021

View full text Add to dashboard Cite

The 2020 Korean Post-cardiac Arrest Care Guidelines are medical recommendations derived based on scientific evidence for post-cardiac arrest care. These guidelines are based on the 2020 scientific consensus and treatment recommendations of the International Liaison Committee on Resuscitation and we additionally considered the research papers in the post-cardiac arrest care field which were published after the International Liaison Committee on Resuscitation review. 1,2 In these guidelines, topics which are clinically important and needed further consideration were reviewed in the form of adaptation or hybridization. Meta-analyses or scoping reviews for addi-S42 www.ceemjournal.org 2020 CPR guidelines: post-cardiac arrest care Use of prophylactic antibioticsThe benefit of the routine use of prophylactic antibiotics in pa-S43

show abstract

Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial)

Abstract: Oxygen titration post-ROSC is feasible in the prehospital environment, but incremental titration commencing at 4L/min oxygen flow may be needed to maintain an oxygen saturation >90% (NCT02499042).

Cited by 49 publications

References 20 publications

The Impact of Hyperoxia in the Critically Ill Patient: A Review of the Literature

The Impact of Hyperoxia in the Critically Ill Patient: A Review of the Literature

Cluster randomised comparison of the effectiveness of 100% oxygen versus titrated oxygen in patients with a sustained return of spontaneous circulation following out of hospital cardiac arrest: a feasibility study. PROXY: post ROSC OXYgenation study

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care

Contact Info

Product

Resources

About