Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial.
Cardiac arrest
Hyperoxemia
Hypoxemia
Mortality
Neurological outcome
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
21 10 2022
21 10 2022
Historique:
received:
21
07
2022
accepted:
04
10
2022
entrez:
22
10
2022
pubmed:
23
10
2022
medline:
26
10
2022
Statut:
epublish
Résumé
Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93-1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95-1.06). The time exposure, i.e., the area under the curve (PaO In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. clinicaltrials.gov NCT02908308 , Registered September 20, 2016.
Sections du résumé
BACKGROUND
Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO
METHODS
Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO
RESULTS
1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93-1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95-1.06). The time exposure, i.e., the area under the curve (PaO
CONCLUSIONS
In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients.
TRIAL REGISTRATION
clinicaltrials.gov NCT02908308 , Registered September 20, 2016.
Identifiants
pubmed: 36271410
doi: 10.1186/s13054-022-04186-8
pii: 10.1186/s13054-022-04186-8
pmc: PMC9585831
doi:
Substances chimiques
Oxygen
S88TT14065
Banques de données
ClinicalTrials.gov
['NCT02908308']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
323Investigateurs
Jan Bělohlávek
(J)
Clifton Callaway
(C)
Alain Cariou
(A)
Tobias Cronberg
(T)
David Erlinge
(D)
Jan Hovdenes
(J)
Hans Kirkegaard
(H)
Helena Levin
(H)
Matt P G Morgan
(MPG)
Per Nordberg
(P)
Mauro Oddo
(M)
Christian Rylander
(C)
Christian Storm
(C)
Susann Ullén
(S)
Matt P Wise
(MP)
Kathy Rowan
(K)
David Harrison
(D)
Paul Mouncey
(P)
Manu Shankar-Hari
(M)
Duncan Young
(D)
Theis Lange
(T)
Karolina Palmér
(K)
Ulla-Britt Karlsson
(UB)
Simon Heissler
(S)
Frances Bass
(F)
John Myburgh
(J)
Colman Taylor
(C)
Adele Bellino
(A)
Marwa Abel-All
(M)
Ben Finfer
(B)
Carolyn Koch
(C)
Yang Li
(Y)
Anne O'Connor
(A)
Julia Pilowsky
(J)
Tina Schneider
(T)
Anna Tippett
(A)
Bridget Ady
(B)
Tessa Broadley
(T)
Amanda Brown
(A)
Liz Melgaard
(L)
Mimi Morgan
(M)
Vanessa Singh
(V)
Rebecca Symons
(R)
Kathrin Becker
(K)
Nathalie Sante
(N)
Vendula Saleova
(V)
Silvie Zerzanova
(S)
Samia Sefir-Kribel
(S)
Ute Lübeck
(U)
Martina Carrara
(M)
Kathryn Fernando
(K)
Diane Mackle
(D)
Leanlove Navarra
(L)
Judith Riley
(J)
Elin Westerheim
(E)
Marianne Flatebø
(M)
Ameldina Ceric
(A)
Zana Haxhija
(Z)
Lovisa Terling
(L)
Lena Bossmar
(L)
Liz Jergle
(L)
Helén Holm Månsson
(HH)
Samia Abed Maillard
(SA)
Andreja Vujicic Zagar
(AV)
Christina Jodlauk
(C)
Jennifer Scrivens
(J)
Kate Ainscough
(K)
Ciara Fahey
(C)
Rinaldo Bellomo
(R)
Leah Peck
(L)
Helen Young
(H)
Winston Cheung
(W)
Rosalba Cross
(R)
Michael Hayes
(M)
Nitin Jain
(N)
Mark Kol
(M)
Asim Shah
(A)
Atul Wagh
(A)
Helen Wong
(H)
F Eduardo Martinez
(F)
Gail Brinkerhoff
(G)
Dustin Bush
(D)
Antony Stewart
(A)
Anders Aneman
(A)
Lien Lombardo
(L)
Peter McCanny
(P)
James Penketh
(J)
Ian Seppelt
(I)
Rebecca Gresham
(R)
Julie Lowrey
(J)
Kristy Masters
(K)
Christina Whitehead
(C)
James Walsham
(J)
Meg Harward
(M)
Josephine Mackay
(J)
Jason Meyer
(J)
Emma Saylor
(E)
Ellen Venz
(E)
Krista Wetzig
(K)
Wade Stedman
(W)
Angela Ashelford
(A)
Sharon Mar
(S)
Miyuki Tokumitsu
(M)
Elizabeth Yarad
(E)
Hergen Buscher
(H)
Claire Reynolds
(C)
Andrew Udy
(A)
Aidan Burrell
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Jasmin Collins
(J)
Dashiell Gantner
(D)
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(VE)
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Vinodh Nanjayya
(V)
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(AS)
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(A)
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(S)
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(R)
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Sebastian Klein
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(AF)
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(L)
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(C)
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(K)
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(V)
Denise Webster
(D)
Thomas Keeble
(T)
Gill Adams
(G)
Rajesh K Aggarwal
(RK)
Jo-Anne Cartwright
(JA)
Steven Church
(S)
Gerald J Clesham
(GJ)
John R Davies
(JR)
Kelly Farrell
(K)
Reto Gamma
(R)
Jane Harding
(J)
Rohan Jagathesan
(R)
Alamgir Kabir
(A)
Paul A Kelly
(PA)
Lauren Kittridge
(L)
Maria Maccaroni
(M)
Gracie Maloney
(G)
Marco Mion
(M)
Naveen Nain
(N)
Raghunath Nalgirkar
(R)
Gyanesh Namjoshi
(G)
Stacey Pepper
(S)
Emily Redman
(E)
Jeremy Sayer
(J)
Amanda Solesbury
(A)
Kare H Tang
(KH)
Sali Urovi
(S)
Kunal Waghmare
(K)
Noel Watson
(N)
Teresa Webber
(T)
Peter Isherwood
(P)
Conor Bentley
(C)
Colin Bergin
(C)
Ronald Carrera
(R)
Amy Clark
(A)
Lauren Cooper
(L)
Liesl Despy
(L)
Natalie Dooley
(N)
Karen Ellis
(K)
Emma Fellows
(E)
Stephanie Goundry
(S)
Samantha Harkett
(S)
Christopher McGhee
(C)
Aoife Neal
(A)
Hazel Smith
(H)
Catherine Snelson
(C)
Elaine Spruce
(E)
Tony Whitehouse
(T)
Kamal Yakoub
(K)
Andrew Walden
(A)
Shauna Bartley
(S)
Parminder Bhuie
(P)
Matthew Frise
(M)
Nicola Jacques
(N)
Liza Keating
(L)
David Pogson
(D)
Zoe Daly
(Z)
Steve Rose
(S)
Jonathan Bannard-Smith
(J)
Rachael Quayle
(R)
Nigel Chee
(N)
Nina Barratt
(N)
Katie Bowman
(K)
Debbie Branney
(D)
Elizabeth Howe
(E)
Maria Letts
(M)
Sally Pitts
(S)
Luke Vamplew
(L)
Clifton W Callaway
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Sara Difiore Sprouse
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Ankur A Doshi
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Jennifer Fugate
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Amy M Headlee
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Eelco F M Wijdicks
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Informations de copyright
© 2022. The Author(s).
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