title: Relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest.
abstract: BACKGROUND
  Laboratory and recent clinical data suggest that hyperoxemia after resuscitation from cardiac arrest is harmful; however, it remains unclear if the risk of adverse outcome is a threshold effect at a specific supranormal oxygen tension, or is a dose-dependent association. We aimed to define the relationship between supranormal oxygen tension and outcome in postresuscitation patients.
  
  
  RESULTS
  This was a multicenter cohort study using the Project IMPACT database (intensive care units at 120 US hospitals). Inclusion criteria were age >17 years, nontrauma, cardiopulmonary resuscitation preceding intensive care unit arrival, and postresuscitation arterial blood gas obtained. We excluded patients with hypoxia or severe oxygenation impairment. We defined the exposure by the highest partial pressure of arterial oxygen (PaO(2)) over the first 24 hours in the ICU. The primary outcome measure was in-hospital mortality. We tested the association between PaO(2) (continuous variable) and mortality using multivariable logistic regression adjusted for patient-oriented covariates and potential hospital effects. Of 4459 patients, 54% died. The median postresuscitation PaO(2) was 231 (interquartile range 149 to 349) mm Hg. Over ascending ranges of oxygen tension, we found significant linear trends of increasing in-hospital mortality and decreasing survival as functionally independent. On multivariable analysis, a 100 mm Hg increase in PaO(2) was associated with a 24% increase in mortality risk (odds ratio 1.24 [95% confidence interval 1.18 to 1.31]. We observed no evidence supporting a single threshold for harm from supranormal oxygen tension.
  
  
  CONCLUSIONS
  In this large sample of postresuscitation patients, we found a dose-dependent association between supranormal oxygen tension and risk of in-hospital death.
authors: Department of Emergency Medicine, Cooper University Hospital, Camden, NJ 08103, USA.
authors: J Hope
authors: JH
authors: Kilgannon
authors: Alan E
authors: AE
authors: Jones
authors: Joseph E
authors: JE
authors: Parrillo
authors: R Phillip
authors: RP
authors: Dellinger
authors: Barry
authors: B
authors: Milcarek
authors: Krystal
authors: K
authors: Hunter
authors: Nathan I
authors: NI
authors: Shapiro
authors: Stephen
authors: S
authors: Trzeciak