title: HyperOxic Therapy OR NormOxic Therapy after out-of-hospital cardiac arrest (HOT OR NOT): a randomised controlled feasibility trial.
abstract: OBJECTIVE
  To investigate the feasibility of delivering titrated oxygen therapy to adults with return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA) caused by ventricular fibrillation (VF) or ventricular tachycardia (VT).
  
  
  METHODS
  We used a multicentre, randomised, single blind, parallel groups design to compare titrated and standard oxygen therapy in adults resuscitated from VF/VT OHCA. The intervention commenced in the community following ROSC and was maintained in the emergency department and the Intensive Care Unit. The primary end point was the median oxygen saturation by pulse oximetry (SpO2) in the pre-hospital period.
  
  
  RESULTS
  159 OHCA patients were screened and 18 were randomised. 17 participants were analysed: nine in the standard care group and eight in the titrated oxygen group. In the pre-hospital period, SpO2 measurements were lower in the titrated oxygen therapy group than the standard care group (difference in medians 11.3%; 95% CI 1.0-20.5%). Low measured oxygen saturation (SpO2<88%) occurred in 7/8 of patients in the titrated oxygen group and 3/9 of patients in the standard care group (P=0.05). Following hospital admission, good separation of oxygen exposure between the groups was achieved without a significant increase in hypoxia events. The trial was terminated because accumulated data led the Data Safety Monitoring Board and Management Committee to conclude that safe delivery of titrated oxygen therapy in the pre-hospital period was not feasible.
  
  
  CONCLUSIONS
  Titration of oxygen in the pre-hospital period following OHCA was not feasible; it may be feasible to titrate oxygen safely after arrival in hospital.
authors.affiliation: Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand; Wellington Hospital, Capital and Coast District Health Board, Private Bag 7902, Wellington, New Zealand. Electronic address: paul.young@ccdhb.org.nz.
authors.forename: Paul
authors.initials: P
authors.lastname: Young
authors.affiliation: Wellington Free Ambulance, PO Box 601, Wellington, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Bailey
authors.affiliation: Intensive Care Unit, Austin Hospital, PO Box 5555, Heidelberg, 3084 Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, The Alfred Centre, Level 6 (Lobby B), 99 Commercial Road, Melbourne, 3004 Victoria, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Alfred Hospital, 55 Commercial Road, Melbourne, 3004 Victoria, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.affiliation: St John Ambulance, 2 Harrison Road, Private Bag 14902, Panmure, Auckland, New Zealand.
authors.forename: Bridget
authors.initials: B
authors.lastname: Dicker
authors.affiliation: Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand; Hawke's Bay Hospital, Omahu Road, Private Bag 9014, Hastings, New Zealand; Chinese University of Hong Kong, Sha Tin, Hong Kong, China.
authors.forename: Ross
authors.initials: R
authors.lastname: Freebairn
authors.affiliation: Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand; Christchurch Hospital, 2 Riccarton Avenue, Christchurch, New Zealand.
authors.forename: Seton
authors.initials: S
authors.lastname: Henderson
authors.affiliation: Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand; Wellington Hospital, Capital and Coast District Health Board, Private Bag 7902, Wellington, New Zealand.
authors.forename: Diane
authors.initials: D
authors.lastname: Mackle
authors.affiliation: Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand; Australian and New Zealand Intensive Care Research Centre, The Alfred Centre, Level 6 (Lobby B), 99 Commercial Road, Melbourne, 3004 Victoria, Australia; Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand.
authors.forename: Colin
authors.initials: C
authors.lastname: McArthur
authors.affiliation: Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand; Australian and New Zealand Intensive Care Research Centre, The Alfred Centre, Level 6 (Lobby B), 99 Commercial Road, Melbourne, 3004 Victoria, Australia; Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand.
authors.forename: Shay
authors.initials: S
authors.lastname: McGuinness
authors.affiliation: St John Ambulance, 2 Harrison Road, Private Bag 14902, Panmure, Auckland, New Zealand; Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand.
authors.forename: Tony
authors.initials: T
authors.lastname: Smith
authors.affiliation: Wellington Hospital, Capital and Coast District Health Board, Private Bag 7902, Wellington, New Zealand; Wellington Free Ambulance, PO Box 601, Wellington, New Zealand.
authors.forename: Andrew
authors.initials: A
authors.lastname: Swain
authors.affiliation: Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand; Wellington Hospital, Capital and Coast District Health Board, Private Bag 7902, Wellington, New Zealand; University of Otago, School of Medicine, PO Box 7343, Wellington South, Wellington, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
authors.affiliation: Medical Research Institute of New Zealand, PO Box 7902, Wellington, New Zealand; Wellington Hospital, Capital and Coast District Health Board, Private Bag 7902, Wellington, New Zealand.
authors.forename: Richard
authors.initials: R
authors.lastname: Beasley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018496:Hyperoxia / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D010092:Oximetry; D010101:Oxygen Consumption; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011446:Prospective Studies; D016037:Single-Blind Method; D017180:Tachycardia, Ventricular / Q000150:complications*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cardiac arrest; Hyperoxia; Oxygen therapy