Abstract
Background
Previous studies have shown an association between hyperoxemia and mortality in patients
with out-of-hospital cardiac arrest (OHCA) after cardiopulmonary resuscitation (CPR);
however, evidence is lacking in the extracorporeal CPR (ECPR) setting.
Objective
The aim of this study was to test the hypothesis that hyperoxemia is associated with
poor neurological outcomes in patients treated by ECPR.
Methods
The Japanese Association for Acute Medicine OHCA Registry is a multicenter, prospective,
observational registry of patients from 2014 to 2017. Adult (18 years or older) patients
who had undergone ECPR after OHCA were included. Eligible patients were divided into
two groups based on the partial pressure of oxygen in arterial blood (PaO2) levels at 24 h after ECPR: the high-PaO2 group (n = 242) defined as PaO2 ≥ 157 mm Hg (median) and the low-PaO2 group (n = 211) defined as PaO2 60 to < 157 mm Hg. The primary outcome was the favorable neurological outcome, defined
as a Cerebral Performance Categories Scale score of 1 to 2 at 30 days after OHCA.
Results
Of 34,754 patients with OHCA, 453 patients were included. The neurological outcome
was significantly lower in the high-PaO2 group than in the low-PaO2 group (15.9 vs. 33.5%; p < 0.001). After adjusting for potential confounders, high PaO2 was negatively associated with favorable neurological outcomes (adjusted odds ratio
[aOR] 0.48; 95% confidence interval [CI] 0.24–0.97; p = 0.040). In a multivariate analysis with multiple imputation, high PaO2 was also negatively associated with favorable neurological outcomes (aOR 0.63; 95%
CI 0.49–0.81; p < 0.001).
Conclusions
Hyperoxemia was associated with worse neurological outcomes in OHCA patients with
ECPR.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart Disease and Stroke Statistics-2020 update: a report from the American Heart Association.Circulation. 2020; 141: e139-e596
- Improving temporal trends in survival and neurological outcomes after out-of-hospital cardiac arrest.Circ Cardiovasc Qual Outcomes. 2018; 11e003561
- Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis.Lancet. 2008; 372: 554-561
- Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest of cardiac origin: a propensity-matched study and predictor analysis.Crit Care Med. 2013; 41: 1186-1196
- An optimal transition time to extracorporeal cardiopulmonary resuscitation for predicting good neurological outcome in patients with out-of-hospital cardiac arrest: a propensity-matched study.Crit Care. 2014; 18: 535
- Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study.Resuscitation. 2014; 85: 762-768
- Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial.Lancet. 2020; 396: 1807-1816
- Post cardiac arrest syndrome: a review of therapeutic strategies.Circulation. 2011; 123: 1428-1435
- Oximetry-guided reoxygenation improves neurological outcome after experimental cardiac arrest.Stroke. 2006; 37: 3008-3013
- Hyperoxic reperfusion after global cerebral ischemia promotes inflammation and long-term hippocampal neuronal death.J Neurotrauma. 2010; 27: 753-762
- Oxygenation, ventilation, and airway management in out-of-hospital cardiac arrest: a review.Biomed Res Int. 2014; 2014376871
- Normoxic ventilation after cardiac arrest reduces oxidation of brain lipids and improves neurological outcome.Stroke. 1998; 29: 1679-1686
- Normoxic resuscitation after cardiac arrest protects against hippocampal oxidative stress, metabolic dysfunction, and neuronal death.J Cereb Blood Flow Metab. 2006; 26: 821-835
- Cardiopulmonary-cerebral resuscitation with 100% oxygen exacerbates neurological dysfunction following nine minutes of normothermic cardiac arrest in dogs.Resuscitation. 1994; 27: 159-170
- European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: post-resuscitation care.Resuscitation. 2021; 161: 220-269
- Hyperoxia is associated with increased mortality in patients treated with mild therapeutic hypothermia after sudden cardiac arrest.Crit Care Med. 2012; 40: 3135-3139
- Association between early hyperoxia exposure after resuscitation from cardiac arrest and neurological disability: prospective multicenter protocol-directed cohort study.Circulation. 2018; 137: 2114-2124
- Conservative or liberal oxygen therapy in adults after cardiac arrest: an individual-level patient data meta-analysis of randomised controlled trials.Resuscitation. 2020; 157: 15-22
- Associations between partial pressure of oxygen and neurological outcome in out-of-hospital cardiac arrest patients: an explorative analysis of a randomized trial.Crit Care. 2019; 23: 30
- The association between arterial oxygen tension and neurological outcome after cardiac arrest.Ther Hypothermia Temp Manag. 2017; 7: 36-41
- Conservative oxygen therapy for mechanically ventilated adults with suspected hypoxic ischaemic encephalopathy.Intensive Care Med. 2020; 46: 2411-2422
- Association between hyperoxemia and mortality in patients treated by eCPR after out-of-hospital cardiac arrest.Am J Emerg Med. 2020; 38: 900-905
- Oxygen thresholds and mortality during extracorporeal life support in adult patients.Crit Care Med. 2017; 45: 1997-2005
- Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality.BMC Cardiovasc Disord. 2021; 21: 542
- The profile of Japanese Association for Acute Medicine - out-of-hospital cardiac arrest registry in 2014-2015.Acute Med Surg. 2018; 5: 249-258
- Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.Resuscitation. 2020; 156: A80-119
- A 5-year experience with cardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest.Resuscitation. 2012; 83: 1331-1337
- Extracorporeal cardiopulmonary resuscitation for in- and out-of-hospital cardiac arrest: systematic review and meta-analysis of propensity score-matched cohort studies.J Am Coll Emerg Physicians Open. 2020; 1: 342-361
- Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest in adult patients.J Am Heart Assoc. 2020; 9e015291
- Association between arterial hyperoxia and outcome in subsets of critical illness: a systematic review, meta-analysis, and meta-regression of cohort studies.Crit Care Med. 2015; 43: 1508-1519
- Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2020; 142: S366-S468
- Do lower target temperatures or prolonged cooling provide improved outcomes for comatose survivors of cardiac arrest treated with hypothermia?.J Am Heart Assoc. 2015; 4e002123
- Therapeutic hypothermia may improve neurological outcomes in extracorporeal life support for adult cardiac arrest.Heart Lung Circ. 2017; 26: 817-824
- Low-flow time is associated with a favorable neurological outcome in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation.J Crit Care. 2018; 48: 15-20
- Neurologic outcomes in patients who undergo extracorporeal cardiopulmonary resuscitation.Ann Thorac Surg. 2019; 108: 749-755
- Does targeted temperature management improve neurological outcome in extracorporeal cardiopulmonary resuscitation (ECPR)?.J Intensive Care Med. 2021; 8850666211018982
- Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a "two-hit" model.Crit Care. 2017; 21: 90
Article info
Publication history
Published online: May 14, 2022
Accepted:
May 9,
2022
Received in revised form:
April 5,
2022
Received:
December 28,
2021
Footnotes
Hiroyuki Tsutsui received honoraria from Otsuka, Takeda Pharmaceutical, Mitsubishi-Tanabe Pharma, Daiichi Sankyo, Nippon Boehringer Ingelheim, Bayer, Pfizer, Novartis Pharma, Ono Pharmaceutical, MSD, Teijin Pharma, and Bristol-Myers Squibb and Astellas Pharma; and received research funding from Nippon Boehringer Ingelheim, Mitsubishi-Tanabe Pharma, Japan Tobacco, Daiichi Sankyo, IQVIA Services Japan, Takeda Pharmaceutical, Bayer Yakuhin, Sanofi, Acterion Pharmaceuticals Japan, and MSD. The remaining authors disclose no conflicts.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
