Journal article
Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study
Resuscitation, Vol.162, pp.82-90
2021
Abstract
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 (<35 mmHg) (adjusted odds ratio [aOR] 0.45, 95% confidence interval [CI] 0.24−0.83) or hypercapnia (>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.
Details
- Title
- Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study
- Authors/Creators
- N. Mckenzie (Author/Creator) - Royal Perth HospitalJ. Finn (Author/Creator) - The University of Western AustraliaG. Dobb (Author/Creator) - The University of Western AustraliaP. Bailey (Author/Creator) - Curtin UniversityG. Arendts (Author/Creator) - Fiona Stanley HospitalA. Celenza (Author/Creator) - Sir Charles Gairdner HospitalD. Fatovich (Author/Creator) - The University of Western AustraliaI. Jenkins (Author/Creator) - Fremantle HospitalS. Ball (Author/Creator) - Curtin UniversityJ. Bray (Author/Creator) - Monash UniversityK.M. Ho (Author/Creator) - The University of Western Australia
- Publication Details
- Resuscitation, Vol.162, pp.82-90
- Publisher
- Elsevier Ireland Ltd
- Identifiers
- 991005545266707891
- Copyright
- © 2021 Elsevier B.V.
- Murdoch Affiliation
- School of Veterinary and Life Sciences
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.134 Trauma & Emergency Surgery
- 1.134.600 Cardiopulmonary Resuscitation
- Web Of Science research areas
- Critical Care Medicine
- Emergency Medicine
- ESI research areas
- Clinical Medicine