Incidence of iatrogenic dyscarbia during mild therapeutic hypothermia after successful resuscitation from out-of-hospital cardiac arrest.
To investigate the incidence of iatrogenic dyscarbia in survivors of out-of-hospital cardiac arrest treated with induced mild hypothermia.We performed a retrospective cohort study of the ventilatory management based on blood gas analyses of patients resuscitated from prehospital cardiac arrest. In the pilot phase, we assessed the ventilatory management in the patients treated in one university hospital during a 4-year study period. Subsequently, a more recent (1-year) retrospective cohort of resuscitated patients from all five Finnish university hospitals concerning the first 48h after hospital admission was analyzed. Core temperatures and temperature corrected (or non-corrected) blood gas analysis results with focus on carbon dioxide tension were analyzed. In addition, a survey was performed to investigate the ventilatory strategies in all Finnish hospitals providing mild hypothermia for cardiac arrest victims.The pilot cohort suggested a high incidence of hypo- or hyper-carbia during hypothermia treatment. In the multicenter patient population of 122 patients contributing a total of 1627 measurements, the PaCO(2) distribution was as follows: less than 4 kPa in 148 samples out of 1627 (9%), 4-4.6 kPa in 404 (25%), 4.7-6 kPa in 887 (55%) and more than 6 kPa in 188 samples (12%). There was a significant difference in the incidence of hypercarbia between the hospitals (p<0.05).We conclude that normocarbia was achieved/maintained only in approximately 55% of the samples. The incidence of hypo- or hyper-carbia (dyscarbia) was high (45%). This may predispose for serious derangements in the cerebral perfusion of the resuscitated patient. These results call for vigilance in adjustment of the ventilatory management to meet the needs of the patients treated with mild hypothermia.
Falkenbach
Patrik
P
Critical Care Medicine Research Group, Department of Intensive Care Medicine, Tampere University Hospital, Tampere, Finland.
Kämäräinen
Antti
A
Mäkelä
Antti
A
Kurola
Jouni
J
Varpula
Tero
T
Ala-Kokko
Tero
T
Perttilä
Juha
J
Tenhunen
Jyrki
J
D000368:Aged; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D016857:Hypocapnia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D007036:Hypothermia, Induced / Q000009:adverse effects*; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010865:Pilot Projects; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
D002245:Carbon Dioxide