title: Hyperoxia, hypocapnia and hypercapnia as outcome factors after cardiac arrest in children.
abstract: OBJECTIVE
  Arterial hyperoxia after resuscitation has been associated with increased mortality in adults. The aim of this study was to test the hypothesis that post-resuscitation hyperoxia and hypocapnia are associated with increased mortality after resuscitation in pediatric patients.
  
  
  METHODS
  We performed a prospective observational multicenter hospital-based study including 223 children aged between 1 month and 18 years who achieved return of spontaneous circulation after in-hospital cardiac arrest and for whom arterial blood gas analysis data were available.
  
  
  RESULTS
  After return of spontaneous circulation, 8.5% of patients had hyperoxia (defined as PaO(2)>300 mm Hg) and 26.5% hypoxia (defined as PaO(2)<60 mm Hg). No statistical differences in mortality were observed when patients with hyperoxia (52.6%), hypoxia (42.4%), or normoxia (40.7%) (p=0.61). Hypocapnia (defined as PaCO(2)<30 mm Hg) was observed in 13.5% of patients and hypercapnia (defined as PaCO(2)>50 mm Hg) in 27.6%. Patients with hypercapnia or hypocapnia had significantly higher mortality (59.0% and 50.0%, respectively) than patients with normocapnia (33.1%) (p=0.002). At 24h after return of spontaneous circulation, neither PaO(2) nor PaCO(2) values were associated with mortality. Multiple logistic regression analysis showed that hypercapnia (OR, 3.27; 95% CI, 1.62-6.61; p=0.001) and hypocapnia (OR, 2.71; 95% CI, 1.04-7.05; p=0.04) after return of spontaneous circulation were significant mortality factors.
  
  
  CONCLUSIONS
  In children resuscitated from cardiac arrest, hyperoxemia after return of spontaneous circulation or 24h later was not associated with mortality. On the other hand, hypercapnia and hypocapnia were associated with higher mortality than normocapnia.
authors: Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors: Jimena
authors: J
authors: Del Castillo
authors: Jesús
authors: J
authors: López-Herce
authors: Martha
authors: M
authors: Matamoros
authors: Sonia
authors: S
authors: Cañadas
authors: Ana
authors: A
authors: Rodriguez-Calvo
authors: Corrado
authors: C
authors: Cechetti
authors: Antonio
authors: A
authors: Rodriguez-Núñez
authors: Angel Carrillo
authors: AC
authors: Alvarez
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D006935:Hypercapnia / Q000453:epidemiology / Q000209:etiology*; D018496:Hyperoxia / Q000453:epidemiology / Q000209:etiology*; D016857:Hypocapnia / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D007223:Infant; D008297:Male; D011446:Prospective Studies