title: Hyperoxia and hypoxia in children resuscitated from cardiac arrest.
abstract: BACKGROUND
  Ischemia depletes antioxidant reserves and impairs mitochondrial electron transport. Oxygen within blood reperfusing ischemic tissue can form free radicals, worsen oxidative stress, and exacerbate tissue injury (reperfusion injury). One strategy for limiting reperfusion injury is to limit delivery of "luxuriant" oxygen during or after reperfusion. Resuscitation guidelines for children with cardiac arrest recommend early weaning of supplemental oxygen as tolerated. There are currently no studies demonstrating the frequency and outcomes of hyperoxia and hypoxia after pediatric cardiac arrest.
  
  
  OBJECTIVE
  To determine the frequency and outcomes of hyperoxia and hypoxia in patients following resuscitation from pediatric cardiac arrest admitted to a tertiary care center.
  
  
  METHODS
  This is a retrospective observational cohort study. Charts of children resuscitated from cardiac arrest and admitted to our hospital from 2004 to 2008 were reviewed. Partial pressures of oxygen (PaO2) obtained within the first 24 hours following return of spontaneous circulation and mortality at 6 months was recorded. Children who did not survive the initial 48 hours, patients having undergone extracorporeal oxygenation or had congenital heart disease, and those in whom arterial blood gases were not obtained were excluded.
  
  
  RESULTS
  Seventy-four patients met inclusion criteria. Of these, 38 (51%) had at least one arterial blood gases with a PaO2 > 300 mm Hg and 10 (14%) had a PaO2 < 60 mm Hg in the first 24 hours. Neither hyperoxia nor hypoxia on initial arterial blood gases (p = 0.912 and p = 0.384) nor any arterial blood gases within the first 24 hours after cardiac arrest (p = 0.325 and p = 0.553) was associated with 6-month mortality.
  
  
  CONCLUSIONS
  Hyperoxia occurs commonly within the first 24 hours of management in children resuscitated from cardiac arrest.
authors: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine and the Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
authors: Melissa M
authors: MM
authors: Guerra-Wallace
authors: Francis L
authors: FL
authors: Casey
authors: Michael J
authors: MJ
authors: Bell
authors: Ericka L
authors: EL
authors: Fink
authors: Robert W
authors: RW
authors: Hickey
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D018496:Hyperoxia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D000860:Hypoxia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects*; D012151:Resuscitation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010100:Oxygen
references: JAMA. 2010 Jun 2;303(21):2165-71
references: 20516417
references: Pediatr Crit Care Med. 2010 Nov;11(6):723-30
references: 20431503
references: Arch Dis Child Fetal Neonatal Ed. 2005 Jan;90(1):F49-52
references: 15613575
references: Resuscitation. 2006 May;69(2):199-206
references: 16500018
references: Pediatrics. 2004 Jul;114(1):157-64
references: 15231922
references: Stroke. 2003 May;34(5):1311-6
references: 12677019
references: Pediatr Res. 1992 Jul;32(1):107-13
references: 1635835
references: Indian Pediatr. 2003 Jun;40(6):510-7
references: 12824660
references: Stroke. 2006 Dec;37(12):3008-13
references: 17068310
references: Pediatrics. 2009 Sep;124(3):e439-49
references: 19661049
references: Resuscitation. 1994 Mar;27(2):141-52
references: 8029536
references: J Exp Biol. 2004 Aug;207(Pt 18):3221-31
references: 15299043
references: J Neurotrauma. 2009 Aug;26(8):1241-9
references: 19505175
references: J Trauma. 1993 Feb;34(2):216-22
references: 8459458
references: Pediatrics. 2001 Apr;107(4):642-7
references: 11335737
references: Pediatrics. 2006 May;117(5):e1005-28
references: 16651281
references: Intensive Care Med. 2012 Jan;38(1):91-8
references: 22127482
references: J Pathol. 2000 Feb;190(3):255-66
references: 10685060
references: Pediatr Res. 2009 Aug;66(2):121-7
references: 19390491
references: J Appl Physiol (1985). 1998 Apr;84(4):1208-16
references: 9516186
references: JAMA. 2006 Jan 4;295(1):50-7
references: 16391216
references: Neurobiol Dis. 2004 Nov;17(2):273-82
references: 15474364
references: Crit Care Med. 2005 Dec;33(12 Suppl):S498-501
references: 16340433
references: Pediatr Res. 2000 Apr;47(4 Pt 1):524-7
references: 10759161
references: Crit Care. 2011;15(2):R90
references: 21385416
references: Stroke. 1999 Oct;30(10):2033-7
references: 10512903
references: Orv Hetil. 2000 Nov 26;141(48):2605-10
references: 11141959
references: Pediatrics. 2002 Mar;109(3):517-9
references: 11875151
references: Stroke. 1998 Aug;29(8):1679-86
references: 9707212
references: Pediatrics. 1998 Jul;102(1):e1
references: 9651453
references: J Appl Physiol (1985). 1993 Nov;75(5):2054-60
references: 8307859
references: Pediatr Res. 2007 Jul;62(1):71-7
references: 17519806
references: Crit Care Med. 2009 Feb;37(2):689-95
references: 19114918
references: Arch Dis Child Fetal Neonatal Ed. 2005 May;90(3):F229-34
references: 15846013
references: Circulation. 2010 Nov 2;122(18 Suppl 3):S876-908
references: 20956230
references: Circulation. 2011 Jun 14;123(23):2717-22
references: 21606393