Optimal Arterial Blood Oxygen Tension in the Early Postresuscitation Phase of Extracorporeal Cardiopulmonary Resuscitation: A 15-Year Retrospective Observational Study
Journal
Critical care medicine
Journal Volume
47
Journal Issue
11
Pages
1549
Date Issued
2019-11-01
Author(s)
Lai, Chien Heng
Tsai, Pi Ru
Chou, Fang Ju
Ko, Wen Je
Abstract
OBJECTIVES: Hyperoxia could lead to a worse outcome after cardiac arrest. Few studies have investigated the impact of oxygenation status on patient outcomes following extracorporeal cardiopulmonary resuscitation. We sought to delineate the association between oxygenation status and neurologic outcomes in patients receiving extracorporeal cardiopulmonary resuscitation. DESIGN: Retrospective analysis of a prospective extracorporeal cardiopulmonary resuscitation registry database. SETTING: An academic tertiary care hospital. PATIENTS: Patients receiving extracorporeal cardiopulmonary resuscitation between 2000 and 2014.None. MEASUREMENTS AND MAIN RESULTS: A total of 291 patients were included, and 80.1% were male. Their mean age was 56.0 years. The arterial blood gas data employed in the primary analysis were recorded from the first sample over the first 24 hours in the ICUs after return of spontaneous circulation. The mean PaO2 after initiation of venoarterial extracorporeal membrane oxygenation was 178.0 mm Hg, and the mean PaO2/FIO2 ratio was 322.0. Only 88 patients (30.2%) demonstrated favorable neurologic status at hospital discharge. Multivariate logistic regression analysis indicated that PaO2 between 77 and 220 mm Hg (odds ratio, 2.29; 95% CI, 1.01-5.22; p = 0.05) and PaO2/FIO2 ratio between 314 and 788 (odds ratio, 5.09; 95% CI, 2.13-12.14; p < 0.001) were both positively associated with favorable neurologic outcomes. CONCLUSIONS: Oxygenation status during extracorporeal membrane oxygenation affects neurologic outcomes in patients receiving extracorporeal cardiopulmonary resuscitation. The PaO2 range of 77 to 220 mm Hg, which is slightly narrower than previously defined, seems optimal. The PaO2/FIO2 ratio was also associated with outcomes in our analysis, indicating that both PaO2 and the PaO2/FIO2 ratio should be closely monitored during the early postcardiac arrest phase for postextracorporeal cardiopulmonary resuscitation patients.
Subjects
cardiac arrest; extracorporeal cardiopulmonary resuscitation; mechanical ventilator; neurologic outcome; oxygen; survival
SDGs
Other Subjects
oxygen; blood; epidemiology; extracorporeal oxygenation; female; heart arrest; human; hyperoxia; hypoxia; intensive care unit; male; middle aged; mortality; register; resuscitation; retrospective study; Taiwan; Cardiopulmonary Resuscitation; Extracorporeal Membrane Oxygenation; Female; Heart Arrest; Humans; Hyperoxia; Hypoxia; Intensive Care Units; Male; Middle Aged; Oxygen; Registries; Retrospective Studies; Taiwan
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Type
journal article