Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study
| Autor: | Antonio Celenza, Kwok M. Ho, Judith Finn, Nicole McKenzie, Glenn Arendts, Geoffrey J. Dobb, Daniel M Fatovich, Paul Bailey, Stephen J. Ball, Janet Bray, Ian Jenkins |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology Emergency Nursing Cohort Studies Hypercapnia 03 medical and health sciences 0302 clinical medicine Hypocapnia Intensive care medicine Humans Normocapnia Retrospective Studies Mechanical ventilation business.industry 030208 emergency & critical care medicine Odds ratio Carbon Dioxide medicine.disease respiratory tract diseases Emergency medicine Emergency Medicine Observational study medicine.symptom Cardiology and Cardiovascular Medicine business Out-of-Hospital Cardiac Arrest circulatory and respiratory physiology Cohort study |
| Zdroj: | Resuscitation. 162:82-90 |
| ISSN: | 0300-9572 |
| DOI: | 10.1016/j.resuscitation.2021.01.035 |
| Popis: | Purpose International guidelines recommend targeting normocapnia in mechanically ventilated out-of-hospital cardiac arrest (OHCA) survivors, but the optimal arterial carbon dioxide (PaCO2) target remains controversial. We hypothesised that the relationship between PaCO2 and survival is non-linear, and targeting an intermediate level of PaCO2 compared to a low or high PaCO2 in the first 24-h of ICU admission is associated with an improved survival to hospital discharge (STHD) and at 12-months. Methods We conducted a retrospective multi-centre cohort study of adults with non-traumatic OHCA requiring admission to one of four tertiary hospital intensive care units for mechanical ventilation. A four-knot restricted cubic spline function was used to allow non-linearity between the mean PaCO2 within the first 24 h of ICU admission after OHCA and survival, and optimal PaCO2 cut-points were identified from the spline curve to generate corresponding odds ratios. Results We analysed 3769 PaCO2 results within the first 24-h of ICU admission, from 493 patients. PaCO2 and survival had an inverted U-shape association; normocapnia was associated with significantly improved STHD compared to either hypocapnia ( 45 mmHg) (aOR 0.45, 95% CI 0.24−0.84). Of the twelve predictors assessed, PaCO2 was the third most important predictor, and explained >11% of the variability in survival. The survival benefits of normocapnia extended to 12-months. Conclusions Normocapnia within the first 24-h of intensive care admission after OHCA was associated with an improved survival compared to patients with hypocapnia or hypercapnia. |
| Databáze: | OpenAIRE |
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