title: The Association Between Arterial Oxygen Tension and Neurological Outcome After Cardiac Arrest.
abstract: A number of observational studies have evaluated the association between arterial oxygen tensions and outcome after cardiac arrest with variable results. The objective of this study is to determine the association between arterial oxygen tension and neurological outcome after cardiac arrest. A retrospective cohort analysis was performed using the Penn Alliance for Therapeutic Hypothermia registry. Adult patients who experienced return of spontaneous circulation after in-hospital or out-of-hospital cardiac arrest (OHCA) and had a partial pressure of arterial oxygen (PaO2) recorded within 48 hours were included. Our primary exposure of interest was PaO2. Hyperoxemia was defined as PaO2> 300 mmHg, hypoxemia as PaO2< 60 mmHg, and optimal oxygenation as PaO260-300 mmHg. The primary outcome was neurological function at hospital discharge among survivors, as described by the cerebral performance category (CPC) score, dichotomized into "favorable" (CPCs 1-2) and "unfavorable" (CPCs 3-5). Secondary outcomes included in-hospital mortality. A total of 544 patients from 13 institutions were included. Average age was 61 years, 56% were male, and 51% were white. A total of 64% experienced OHCA, 81% of arrests were witnessed, and pulseless electrical activity was the most common initial rhythm (40%). More than 72% of the patients had cardiac etiology for their arrests, and 55% underwent targeted temperature management. A total of 38% of patients survived to hospital discharge. There was no significant association between PaO2at any time interval and neurological outcome at hospital discharge. Hyperoxemia at 12 hours after cardiac arrest was associated with decreased odds of survival (OR 0.17 [0.03-0.89], p = 0.032). There was no significant association between arterial oxygen tension measured within the first 48 hours after cardiac arrest and neurological outcome.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, University of Washington , Seattle, Washington.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Johnson
authors.affiliation: 2 School of Public Health, Drexel University , Philadelphia, Pennsylvania.
authors.forename: Kalani
authors.initials: K
authors.lastname: Dodampahala
authors.affiliation: 2 School of Public Health, Drexel University , Philadelphia, Pennsylvania.|3 OhioHealth , Columbus, Ohio.
authors.forename: Babette
authors.initials: B
authors.lastname: Rosselot
authors.affiliation: 4 Department of Emergency Medicine, University of Colorado School of Medicine , Aurora, Colorado.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Perman
authors.affiliation: 5 Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
authors.affiliation: 6 Department of Emergency Medicine, Medstar Washington Hospital Center , Washington, District of Columbia.
authors.forename: Munish
authors.initials: M
authors.lastname: Goyal
authors.affiliation: 7 Department of Emergency Medicine, Thomas Jefferson University , Philadelphia, Pennsylvania.
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
authors.affiliation: 8 Department of Emergency Medicine, Center for Resuscitation Science, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, Pennsylvania.
authors.forename: Anne V
authors.initials: AV
authors.lastname: Grossestreuer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D018496:Hyperoxia / Q000097:blood / Q000401:mortality / Q000503:physiopathology; D007036:Hypothermia, Induced; D000860:Hypoxia / Q000097:blood / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology*; D010100:Oxygen / Q000097:blood*; D010313:Partial Pressure; D020127:Recovery of Function; D012042:Registries; D012121:Respiration, Artificial; D012151:Resuscitation / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D015415:Biomarkers; D010100:Oxygen
keywords: cardiac arrest; critical care; hyperoxia; post-arrest care; ventilator management