Nicole McKenzie1, Teresa A Williams2, Hideo Tohira3, Kwok M Ho4, Judith Finn5. 1. Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia; Royal Perth Hospital, Perth, WA, Australia. Electronic address: nicole.mckenzie@student.curtin.edu.au. 2. Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia; St John Ambulance Western Australia, Belmont, WA, Australia; Royal Perth Hospital, Perth, WA, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, WA, Australia. 3. Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, WA, Australia. 4. Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia; Royal Perth Hospital, Perth, WA, Australia. 5. Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia; St John Ambulance Western Australia, Belmont, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, WA, Australia.
Abstract
INTRODUCTION: Arterial carbon dioxide tension (PaCO2) abnormalities are common after cardiac arrest (CA). Maintaining a normal PaCO2 makes physiological sense and is recommended as a therapeutic target after CA, but few studies have examined the association between PaCO2 and patient outcomes. This systematic review and meta-analysis aimed to assess the effect of a low or high PaCO2 on patient outcomes after CA. METHODS: We searched MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL, for studies that evaluated the association between PaCO2 and outcomes after CA. The primary outcome was hospital survival. Secondary outcomes included neurological status at the end of each study's follow up period, hospital discharge destination and 30-day survival. Meta-analysis was conducted if statistical heterogeneity was low. RESULTS: The systematic review included nine studies; eight provided sufficient quantitative data for meta-analysis. Using PaCO2 cut-points of <35mmHg and >45mmHg to define hypo- and hypercarbia, normocarbia was associated with increased hospital survival (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.23, 1.38). Normocarbia was also associated with a good neurological outcome (cerebral performance category score 1 or 2) compared to hypercarbia (OR 1.69, 95% CI 1.13, 2.51) when the analysis also included an additional study with a slightly different definition for normocarbia (PaCO2 30-50mmHg). CONCLUSIONS: From the limited data it appears PaCO2 has an important U-shape association with survival and outcomes after CA, consistent with international resuscitation guidelines' recommendation that normocarbia be targeted during post-resuscitation care.
INTRODUCTION: Arterial carbon dioxide tension (PaCO2) abnormalities are common after cardiac arrest (CA). Maintaining a normal PaCO2 makes physiological sense and is recommended as a therapeutic target after CA, but few studies have examined the association between PaCO2 and patient outcomes. This systematic review and meta-analysis aimed to assess the effect of a low or high PaCO2 on patient outcomes after CA. METHODS: We searched MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL, for studies that evaluated the association between PaCO2 and outcomes after CA. The primary outcome was hospital survival. Secondary outcomes included neurological status at the end of each study's follow up period, hospital discharge destination and 30-day survival. Meta-analysis was conducted if statistical heterogeneity was low. RESULTS: The systematic review included nine studies; eight provided sufficient quantitative data for meta-analysis. Using PaCO2 cut-points of <35mmHg and >45mmHg to define hypo- and hypercarbia, normocarbia was associated with increased hospital survival (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.23, 1.38). Normocarbia was also associated with a good neurological outcome (cerebral performance category score 1 or 2) compared to hypercarbia (OR 1.69, 95% CI 1.13, 2.51) when the analysis also included an additional study with a slightly different definition for normocarbia (PaCO2 30-50mmHg). CONCLUSIONS: From the limited data it appears PaCO2 has an important U-shape association with survival and outcomes after CA, consistent with international resuscitation guidelines' recommendation that normocarbia be targeted during post-resuscitation care.
Authors: Arne Diehl; Aidan J C Burrell; Andrew A Udy; Peta M A Alexander; Peter T Rycus; Ryan P Barbaro; Vincent A Pellegrino; David V Pilcher Journal: Crit Care Med Date: 2020-07 Impact factor: 7.598
Authors: Pekka Jakkula; Matti Reinikainen; Johanna Hästbacka; Pekka Loisa; Marjaana Tiainen; Ville Pettilä; Jussi Toppila; Marika Lähde; Minna Bäcklund; Marjatta Okkonen; Stepani Bendel; Thomas Birkelund; Anni Pulkkinen; Jonna Heinonen; Tuukka Tikka; Markus B Skrifvars Journal: Intensive Care Med Date: 2018-11-14 Impact factor: 17.440