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01-12-2020 | Care | Research

The interaction between arterial oxygenation and carbon dioxide and hospital mortality following out of hospital cardiac arrest: a cohort study

Authors: Peter J. McGuigan, Manu Shankar-Hari, David A. Harrison, John G. Laffey, Danny F. McAuley

Published in: Critical Care | Issue 1/2020

Abstract

Background

Outcomes following out of hospital cardiac arrest (OHCA) are poor. The optimal arterial oxygen and carbon dioxide (PaCO₂) levels for managing patients following OHCA are unknown. We hypothesized that abnormalities in arterial oxygenation (PaO₂/FiO₂ ratio or PaO₂) and PaCO₂ would be associated with hospital mortality following OHCA. We hypothesized that PaCO₂ would significantly modify the oxygenation–mortality relationship.

Methods

This was an observational cohort study using data from OHCA survivors admitted to adult critical care units in England, Wales and Northern Ireland from 2011 to 2018. Logistic regression analyses were performed to assess the relationship between hospital mortality and oxygenation and PaCO₂.

Results

The analysis included 23,625 patients. In comparison with patients with a PaO₂/FiO₂ > 300 mmHg, those with a PaO₂/FiO₂ ≤ 100 mmHg had higher mortality (adjusted OR, 1.79; 95% CI, 1.48 to 2.15; P < 0.001). In comparison to hyperoxemia (PaO₂ > 100 mmHg), patients with hypoxemia (PaO₂ < 60 mmHg) had higher mortality (adjusted OR, 1.34; 95% CI, 1.10 to 1.65; P = 0.004). In comparison with normocapnia, hypercapnia was associated with lower mortality. Hypocapnia (PaCO2 ≤ 35 mmHg) was associated with higher mortality (adjusted OR, 1.91; 95% CI, 1.63 to 2.24; P < 0.001). PaCO₂ modified the PaO₂/FiO₂–mortality and PaO₂–mortality relationships, though these relationships were complex. Patients who were both hyperoxic and hypercapnic had the lowest mortality.

Conclusions

Low PaO₂/FiO₂ ratio, hypoxemia and hypocapnia are associated with higher mortality following OHCA. PaCO₂ modifies the relationship between oxygenation and mortality following OHCA; future studies examining this interaction are required.

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Title: The interaction between arterial oxygenation and carbon dioxide and hospital mortality following out of hospital cardiac arrest: a cohort study
Authors: Peter J. McGuigan
Manu Shankar-Hari
David A. Harrison
John G. Laffey
Danny F. McAuley
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Care
Hypoxemia
Published in: Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-020-03039-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The interaction between arterial oxygenation and carbon dioxide and hospital mortality following out of hospital cardiac arrest: a cohort study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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