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7. Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest

Author

Eastwood, Glenn, primary, Nichol, Alistair D., additional, Hodgson, Carol, additional, Parke, Rachael L., additional, McGuinness, Shay, additional, Nielsen, Niklas, additional, Bernard, Stephen, additional, Skrifvars, Markus B., additional, Stub, Dion, additional, Taccone, Fabio S., additional, Archer, John, additional, Kutsogiannis, Demetrios, additional, Dankiewicz, Josef, additional, Lilja, Gisela, additional, Cronberg, Tobias, additional, Kirkegaard, Hans, additional, Capellier, Gilles, additional, Landoni, Giovanni, additional, Horn, Janneke, additional, Olasveengen, Theresa, additional, Arabi, Yaseen, additional, Chia, Yew Woon, additional, Markota, Andrej, additional, Hænggi, Matthias, additional, Wise, Matt P., additional, Grejs, Anders M., additional, Christensen, Steffen, additional, Munk-Andersen, Heidi, additional, Granfeldt, Asger, additional, Andersen, Geir Ø., additional, Qvigstad, Eirik, additional, Flaa, Arnljot, additional, Thomas, Matthew, additional, Sweet, Katie, additional, Bewley, Jeremy, additional, Bäcklund, Minna, additional, Tiainen, Marjaana, additional, Iten, Manuela, additional, Levis, Anja, additional, Peck, Leah, additional, Walsham, James, additional, Deane, Adam, additional, Ghosh, Angajendra, additional, Annoni, Filippo, additional, Chen, Yan, additional, Knight, David, additional, Lesona, Eden, additional, Tlayjeh, Haytham, additional, Svenšek, Franc, additional, McGuigan, Peter J., additional, Cole, Jade, additional, Pogson, David, additional, Hilty, Matthias P., additional, Düring, Joachim P., additional, Bailey, Michael J., additional, Paul, Eldho, additional, Ady, Bridget, additional, Ainscough, Kate, additional, Hunt, Anna, additional, Monahan, Sinéad, additional, Trapani, Tony, additional, Fahey, Ciara, additional, and Bellomo, Rinaldo, additional

Published
2023
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9. Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest

Author

Eastwood, Glenn, Nichol, Alistair D, Hodgson, Carol, Parke, Rachael L, McGuinness, Shay, Nielsen, Niklas, Bernard, Stephen, Skrifvars, Markus B, Stub, Dion, Taccone, Fabio S, Archer, John, Kutsogiannis, Demetrios, Dankiewicz, Josef, Lilja, Gisela, Cronberg, Tobias, Kirkegaard, Hans, Capellier, Gilles, Landoni, Giovanni, Horn, Janneke, Olasveengen, Theresa, Arabi, Yaseen, Chia, Yew Woon, Markota, Andrej, Hænggi, Matthias, Wise, Matt P, Grejs, Anders M, Christensen, Steffen, Munk-Andersen, Heidi, Granfeldt, Asger, Andersen, Geir Ø, Qvigstad, Eirik, Flaa, Arnljot, Thomas, Matthew, Sweet, Katie, Bewley, Jeremy, Bäcklund, Minna, Tiainen, Marjaana, Iten, Manuela, Levis, Anja, Peck, Leah, Walsham, James, Deane, Adam, Ghosh, Angajendra, Annoni, Filippo, Knight, David, Lesona, Eden, Tlayjeh, Haytham, Svenšek, Franc, and McGuigan, Peter J

Subjects
Adult, Hospitalization, Hypercapnia/complications, Coma/complications, Humans, Carbon Dioxide, Out-of-Hospital Cardiac Arrest/therapy
Abstract

BACKGROUND: Guidelines recommend normocapnia for adults with coma who are resuscitated after out-of-hospital cardiac arrest. However, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes.METHODS: We randomly assigned adults with coma who had been resuscitated after out-of-hospital cardiac arrest of presumed cardiac or unknown cause and admitted to the intensive care unit (ICU) in a 1:1 ratio to either 24 hours of mild hypercapnia (target partial pressure of arterial carbon dioxide [Paco2], 50 to 55 mm Hg) or normocapnia (target Paco2, 35 to 45 mm Hg). The primary outcome was a favorable neurologic outcome, defined as a score of 5 (indicating lower moderate disability) or higher, as assessed with the use of the Glasgow Outcome Scale-Extended (range, 1 [death] to 8, with higher scores indicating better neurologic outcome) at 6 months. Secondary outcomes included death within 6 months.RESULTS: A total of 1700 patients from 63 ICUs in 17 countries were recruited, with 847 patients assigned to targeted mild hypercapnia and 853 to targeted normocapnia. A favorable neurologic outcome at 6 months occurred in 332 of 764 patients (43.5%) in the mild hypercapnia group and in 350 of 784 (44.6%) in the normocapnia group (relative risk, 0.98; 95% confidence interval [CI], 0.87 to 1.11; P = 0.76). Death within 6 months after randomization occurred in 393 of 816 patients (48.2%) in the mild hypercapnia group and in 382 of 832 (45.9%) in the normocapnia group (relative risk, 1.05; 95% CI, 0.94 to 1.16). The incidence of adverse events did not differ significantly between groups.CONCLUSIONS: In patients with coma who were resuscitated after out-of-hospital cardiac arrest, targeted mild hypercapnia did not lead to better neurologic outcomes at 6 months than targeted normocapnia. (Funded by the National Health and Medical Research Council of Australia and others; TAME ClinicalTrials.gov number, NCT03114033.).

Published
2023
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23. Personality may influence reactivity to stress

Author

Ekeberg Øivind, Flaa Arnljot, Kjeldsen Sverre, and Rostrup Morten

Subjects
Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

Abstract Background Possible mechanisms behind psychophysiological hyperreactivity may be located at a cognitive-emotional level. Several personality traits have been associated with increased cardiovascular reactivity. Subjects with white coat hypertension, which may constitute a kind of hyperreactivity, are found to suppress their emotions and adapt to the surroundings to a larger extent than controls. We hypothesized in this study that a) stress reactivity is related to personality, and that b) responses to cold pressor test (CPT) and mental stress test (MST) are associated with different personality traits. Methods 87 men were selected from the 1st, 50th and 99th percentile of a blood pressure screening. Cardiovascular and catecholamine responses to MST and CPT were recorded. Fifteen personality traits were assessed using the Karolinska Scale of Personality. Possible independent explanatory predictors for cardiovascular and catecholamine variables at baseline and during stress were analyzed in multiple linear regression analyses using a stepwise forward procedure. Results Multiple regression analyses showed that muscular tension (β = 0.298, p = 0.004), irritability (β = 0.282, p = 0.016), detachment (β = 0.272, p = 0.017), psychasthenia (β = 0.234, p = 0.031) and somatic anxiety (β = 0.225, p = 0.046) were significant explanatory variables of reactivity to CPT. During MST, verbal aggression (β = -0.252, 0.031) and detachment (β = 0.253, p = 0.044) were significant predictors of norepinephrine and diastolic blood pressure response, respectively. Based on KSP-trait quartiles, delta (Δ) systolic (p = 0.025) and Δ diastolic blood pressure (p = 0.003) during MST were related to detachment score, with the highest reactivity in the 4th quartile, while Δ norepinephrine was significantly related to muscular tension (p = 0.033). Δ systolic and Δ diastolic blood pressure responses to CPT were dependent on detachment (p = 0.049 and p = 0.011, respectively) and psychasthenia (p = 0.020 and p = 0.015), while high verbal aggression was associated with lower reactivity measured by Δ norepinephrine (p = 0.037). Conclusion The present study indicates that stress reactivity is clearly related to different personality traits, without any single trait being dominant over others. Furthermore, personality seems to have as much, or even more, importance of predicting responses to CPT than responses to MST.

Published
2007
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26. Magnetic resonance imaging in comatose adults resuscitated after out-of-hospital cardiac arrest: A posthoc study of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest trial

Author

Eastwood, Glenn M., Bailey, Michael, Nichol, Alistair D., Dankiewicz, Josef, Nielsen, Niklas, Parke, Rachael, Cronberg, Tobias, Olasveengen, Theresa, Grejs, Anders M., Iten, Manuela, Haenggi, Matthias, McGuigan, Peter, Wagner, Franca, Moseby-Knappe, Marion, Lang, Margareta, Bellomo, Rinaldo, Hodgson, Carol, McGuinness, Shay, Bernard, Stephen, Skrifvars, Markus B., Stub, Dion, Taccone, Fabio S., Archer, John, Kutsogiannis, Demetrios, Lilja, Gisela, Kirkegaard, Hans, Capellier, Gilles, Landoni, Giovanni, Horn, Janneke, Arabi, Yaseen, Chia, Yew Woon, Markota, Andrej, Wise, Matt P., Christensen, Steffen, Munk-Andersen, Heidi, Granfeldt, Asger, Andersen, Geir Ø., Qvigstad, Eirik, Flaa, Arnljot, Thomas, Matthew, Sweet, Katie, Bewley, Jeremy, Bäcklund, Minna, Tiainen, Marjaana, Levis, Anja, Peck, Leah, Walsham, James, Deane, Adam, Ghosh, Angajendra, Annoni, Filippo, Chen, Yan, Knight, David, Lesona, Eden, Tlayjeh, Haytham, Svenšek, Franc, Cole, Jade, Pogson, David, Hilty, Matthias P., Düring, Joachim P., Paul, Eldho, Ady, Bridget, Ainscough, Kate, Hunt, Anna, Monahan, Sinéad, Trapani, Tony, and Fahey, Ciara

Abstract

Neuroimaging with magnetic resonance imaging (MRI) may assist clinicians in evaluating brain injury and optimising care in comatose adults resuscitated after out-of-hospital cardiac arrest (OHCA). However, contemporary international data on its use are lacking.

Published
2024
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36. Gender specific sympathetic and hemorrheological responses to mental stress in healthy young subjects.

Author

Ross, Anne Elisabeth, Flaa, Arnljot, Høieggen, Aud, Reims, Henrik, Eide, Ivar K., Kjeldsen, Sverre E., Ross, A E, Flaa, A, Høieggen, A, Reims, H, Eide, I K, and Kjeldsen, S E

Subjects
*BLOOD viscosity, *PSYCHOLOGICAL stress, *STUDENTS, *ADRENALINE, *BIOPHYSICS, *DEMOGRAPHY, *HEMATOCRIT, *NORADRENALINE, *REGRESSION analysis, *SEX distribution, *SYMPATHETIC nervous system, *LEUKOCYTE count
Abstract

Objective - Activation of the sympathetic nervous system may increase hematocrit (Hct), whole blood viscosity (WBV), and possibly cardiovascular risk. The aim was to study gender specific differences of mental stress on sympathetic reactivity and blood rheology. Methods - Responses in blood pressure, heart rate (HR), Hct, WBV (Bohlin rotational viscosimeter), and plasma catecholamines to a mental arithmetic stress test (MST) were measured in male (n = 10, 23 ± 3 years, BMI 23 ± 2 kg/m2) and female (n = 10, 21 ± 4 years, BMI 24 ± 2 kg/m2) students. Results - Systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR increased during MST in men and women, and declined to baseline levels after 15 min of recovery. In men, plasma adrenaline increased by 217% during MST (p < 0.01, ANOVA), and plasma noradrenaline increased by 68% (p < 0.05). Hct and WBV at low shear rates (0.5 and 1.1 l/s) increased as well (p < 0.01, p < 0.05, and p < 0.05, respectively). In women, the increase in plasma adrenaline averaged 118% during MST (p < 0.05) while plasma noradrenaline (-3%, p = 0.38), Hct, and WBV at all shear rates remained unchanged. Men and women differed in Δ adrenaline (p < 0.05), Δ noradrenaline (p = 0.01), Δ Hct (p < 0.05), and Δ WBV (p < 0.05). Δ Hct tended to correlate with Δ SBP (r = 0.60, p = 0.07), Δ DBP (r = 0.57, p = 0.09), and Δ HR (r = 0.50, p = 0.14), and correlated significantly with Δ noradrenaline (r = 0.66, p < 0.05) in men only. Multiple regression analysis showed that gender independently explained 22% of the change in Hct during mental stress. Conclusion - Data suggest gender specific differences in sympathetic and hemorrheological responses to mental stress in healthy young subjects. In men, sympathetic responses were related to hemorrheological responses, but not in women. It may be speculated whether such differences in stress responses may contribute to lower cardiovascular risk in premenopausal women than in men. [ABSTRACT FROM AUTHOR]

Published
2001
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