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Critical Care
Published in: Critical Care 1/2015

Open Access 01-12-2015 | Research

Exposure to high concentrations of inspired oxygen does not worsen lung injury after cardiac arrest

Authors: Jonathan Elmer, Bo Wang, Samer Melhem, Raghevesh Pullalarevu, Nishit Vaghasia, Jaya Buddineni, Bedda L Rosario, Ankur A Doshi, Clifton W Callaway, Cameron Dezfulian, on behalf of the University of Pittsburgh Post-Cardiac Arrest Service (PCAS)

Published in: Critical Care | Issue 1/2015

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Abstract

Introduction

Post-cardiac arrest patients are often exposed to 100% oxygen during cardiopulmonary resuscitation and the early post-arrest period. It is unclear whether this contributes to development of pulmonary dysfunction or other patient outcomes.

Methods

We performed a retrospective cohort study including post-arrest patients who survived and were mechanically ventilated at least 24 hours after return of spontaneous circulation. Our primary exposure of interest was inspired oxygen, which we operationalized by calculating the area under the curve of the fraction of inspired oxygen (FiO2AUC) for each patient over 24 hours. We collected baseline demographic, cardiovascular, pulmonary and cardiac arrest-specific covariates. Our main outcomes were change in the respiratory subscale of the Sequential Organ Failure Assessment score (SOFA-R) and change in dynamic pulmonary compliance from baseline to 48 hours. Secondary outcomes were survival to hospital discharge and Cerebral Performance Category at discharge.

Results

We included 170 patients. The first partial pressure of arterial oxygen (PaO2):FiO2 ratio was 241 ± 137, and 85% of patients had pulmonary failure and 55% had cardiovascular failure at presentation. Higher FiO2AUC was not associated with change in SOFA-R score or dynamic pulmonary compliance from baseline to 48 hours. However, higher FiO2AUC was associated with decreased survival to hospital discharge and worse neurological outcomes. This was driven by a 50% decrease in survival in the highest quartile of FiO2AUC compared to other quartiles (odds ratio for survival in the highest quartile compared to the lowest three quartiles 0.32 (95% confidence interval 0.13 to 0.79), P = 0.003).

Conclusions

Higher exposure to inhaled oxygen in the first 24 hours after cardiac arrest was not associated with deterioration in gas exchange or pulmonary compliance after cardiac arrest, but was associated with decreased survival and worse neurological outcomes.
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Metadata
Title
Exposure to high concentrations of inspired oxygen does not worsen lung injury after cardiac arrest
Authors
Jonathan Elmer
Bo Wang
Samer Melhem
Raghevesh Pullalarevu
Nishit Vaghasia
Jaya Buddineni
Bedda L Rosario
Ankur A Doshi
Clifton W Callaway
Cameron Dezfulian
on behalf of the University of Pittsburgh Post-Cardiac Arrest Service (PCAS)
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-015-0824-x

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