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Open Access 01-12-2018 | Original

Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial

Authors: Pekka Jakkula, Matti Reinikainen, Johanna Hästbacka, Pekka Loisa, Marjaana Tiainen, Ville Pettilä, Jussi Toppila, Marika Lähde, Minna Bäcklund, Marjatta Okkonen, Stepani Bendel, Thomas Birkelund, Anni Pulkkinen, Jonna Heinonen, Tuukka Tikka, Markus B. Skrifvars, COMACARE study group

Published in: Intensive Care Medicine | Issue 12/2018

Abstract

Purpose

We assessed the effects of targeting low-normal or high-normal arterial carbon dioxide tension (PaCO₂) and normoxia or moderate hyperoxia after out-of-hospital cardiac arrest (OHCA) on markers of cerebral and cardiac injury.

Methods

Using a 2³ factorial design, we randomly assigned 123 patients resuscitated from OHCA to low-normal (4.5–4.7 kPa) or high-normal (5.8–6.0 kPa) PaCO₂ and to normoxia (arterial oxygen tension [PaO₂] 10–15 kPa) or moderate hyperoxia (PaO₂ 20–25 kPa) and to low-normal or high-normal mean arterial pressure during the first 36 h in the intensive care unit. Here we report the results of the low-normal vs. high-normal PaCO₂ and normoxia vs. moderate hyperoxia comparisons. The primary endpoint was the serum concentration of neuron-specific enolase (NSE) 48 h after cardiac arrest. Secondary endpoints included S100B protein and cardiac troponin concentrations, continuous electroencephalography (EEG) and near-infrared spectroscopy (NIRS) results and neurologic outcome at 6 months.

Results

In total 120 patients were included in the analyses. There was a clear separation in PaCO₂ (p < 0.001) and PaO₂ (p < 0.001) between the groups. The median (interquartile range) NSE concentration at 48 h was 18.8 µg/l (13.9–28.3 µg/l) in the low-normal PaCO₂ group and 22.5 µg/l (14.2–34.9 µg/l) in the high-normal PaCO₂ group, p = 0.400; and 22.3 µg/l (14.8–27.8 µg/l) in the normoxia group and 20.6 µg/l (14.2–34.9 µg/l) in the moderate hyperoxia group, p = 0.594). High-normal PaCO₂ and moderate hyperoxia increased NIRS values. There were no differences in other secondary outcomes.

Conclusions

Both high-normal PaCO₂ and moderate hyperoxia increased NIRS values, but the NSE concentration was unaffected.

Registration

ClinicalTrials.gov, NCT02698917. Registered on January 26, 2016.

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Title: Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial
Authors: Pekka Jakkula
Matti Reinikainen
Johanna Hästbacka
Pekka Loisa
Marjaana Tiainen
Ville Pettilä
Jussi Toppila
Marika Lähde
Minna Bäcklund
Marjatta Okkonen
Stepani Bendel
Thomas Birkelund
Anni Pulkkinen
Jonna Heinonen
Tuukka Tikka
Markus B. Skrifvars
COMACARE study group
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5453-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial

Abstract

Purpose

Methods

Results

Conclusions

Registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Registration

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