1. Optimal Arterial Blood Oxygen Tension in the Early Postresuscitation Phase of Extracorporeal Cardiopulmonary Resuscitation: A 15-Year Retrospective Observational Study
- Author
-
Wen-Jone Chen, Yih-Sharng Chen, Chien-Hua Huang, Hsi-Yu Yu, Chien-Heng Lai, Pi-Ru Tsai, Fang-Ju Chou, Wei-Tien Chang, Shu-Chien Huang, Chih-Hsien Wang, Chih-Hung Wang, Nai-Kuan Chou, Min-Shan Tsai, and Wen-Je Ko
- Subjects
Male ,medicine.medical_treatment ,Taiwan ,Return of spontaneous circulation ,Hyperoxia ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Extracorporeal Membrane Oxygenation ,Extracorporeal membrane oxygenation ,Medicine ,Humans ,Extracorporeal cardiopulmonary resuscitation ,Cardiopulmonary resuscitation ,Registries ,Hypoxia ,Retrospective Studies ,business.industry ,030208 emergency & critical care medicine ,Retrospective cohort study ,Odds ratio ,Middle Aged ,Cardiopulmonary Resuscitation ,respiratory tract diseases ,Oxygen tension ,Heart Arrest ,Oxygen ,Intensive Care Units ,030228 respiratory system ,Anesthesia ,Arterial blood ,Female ,business - 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. INTERVENTIONS 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.
- Published
- 2019