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Intensive Care Medicine
Published in: Intensive Care Medicine 8/2022

Open Access 02-07-2022 | Original

Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

Authors: Chiara Robba, Rafael Badenes, Denise Battaglini, Lorenzo Ball, Iole Brunetti, Janus C. Jakobsen, Gisela Lilja, Hans Friberg, Pedro D. Wendel-Garcia, Paul J. Young, Glenn Eastwood, Michelle S. Chew, Johan Unden, Matthew Thomas, Michael Joannidis, Alistair Nichol, Andreas Lundin, Jacob Hollenberg, Naomi Hammond, Manoj Saxena, Martin Annborn, Miroslav Solar, Fabio S. Taccone, Josef Dankiewicz, Niklas Nielsen, Paolo Pelosi, TTM2 Trial Collaborators

Published in: Intensive Care Medicine | Issue 8/2022

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Abstract

Purpose

The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes.

Methods

Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization.

Results

A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (VT) was 7 (Interquartile range, IQR = 6.2–8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5–9) cmH20, plateau pressure was 20 cmH20 (IQR = 17–23), driving pressure was 12 cmH20 (IQR = 10–15), mechanical power 16.2 J/min (IQR = 12.1–21.8), ventilatory ratio was 1.27 (IQR = 1.04–1.6), and respiratory rate was 17 breaths/minute (IQR = 14–20). Median partial pressure of oxygen was 87 mmHg (IQR = 75–105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36–45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003–1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001–1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome.

Conclusions

Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes.
Appendix
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Metadata
Title
Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial
Authors
Chiara Robba
Rafael Badenes
Denise Battaglini
Lorenzo Ball
Iole Brunetti
Janus C. Jakobsen
Gisela Lilja
Hans Friberg
Pedro D. Wendel-Garcia
Paul J. Young
Glenn Eastwood
Michelle S. Chew
Johan Unden
Matthew Thomas
Michael Joannidis
Alistair Nichol
Andreas Lundin
Jacob Hollenberg
Naomi Hammond
Manoj Saxena
Martin Annborn
Miroslav Solar
Fabio S. Taccone
Josef Dankiewicz
Niklas Nielsen
Paolo Pelosi
TTM2 Trial Collaborators
Publication date
02-07-2022
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 8/2022
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-022-06756-4

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