Paul J Young1, Michael Bailey2, Rinaldo Bellomo3, Stephen Bernard4, Janet Bray4, Pekka Jakkula5, Markku Kuisma6, Diane Mackle7, Daniel Martin8, Jerry P Nolan9, Rakshit Panwar10, Matti Reinikainen11, Markus B Skrifvars12, Matt Thomas13. 1. Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand. Electronic address: paul.young@ccdhb.org.nz. 2. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia. 3. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia; Intensive Care Unit, Austin Hospital, Heidelberg, Victoria, Australia; Centre for Integrated Critical Care, University of Melbourne, Parkville, Victoria, Australia. 4. Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia. 5. Department of Perioperative, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Finland. 6. Department of Emergency Medicine, Helsinki University Hospital, Finland. 7. Medical Research Institute of New Zealand, Wellington, New Zealand. 8. Intensive Care Unit, Royal Free Hospital, London, UK; Peninsula Medical School, University of Plymouth, UK. 9. Warwick Clinical Trials Unit, University of Warwick, Coventry, UK; Consultant in Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK. 10. Intensive Care Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. 11. Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland. 12. Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland. 13. Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Abstract
AIM: The effect of conservative versus liberal oxygen therapy on mortality rates in post cardiac arrest patients is uncertain. METHODS: We undertook an individual patient data meta-analysis of patients randomised in clinical trials to conservative or liberal oxygen therapy after a cardiac arrest. The primary end point was mortality at last follow-up. RESULTS: Individual level patient data were obtained from seven randomised clinical trials with a total of 429 trial participants included. Four trials enrolled patients in the pre-hospital period. Of these, two provided protocol-directed oxygen therapy for 60 min, one provided it until the patient was handed over to the emergency department staff, and one provided it for a total of 72 h or until the patient was extubated. Three trials enrolled patients after intensive care unit (ICU) admission and generally continued protocolised oxygen therapy for a longer period, often until ICU discharge. A total of 90 of 221 patients (40.7%) assigned to conservative oxygen therapy and 103 of 206 patients (50%) assigned to liberal oxygen therapy had died by this last point of follow-up; absolute difference; odds ratio (OR) adjusted for study only; 0.67; 95% CI 0.45 to 0.99; P = 0.045; adjusted OR, 0.58; 95% CI 0.35 to 0.96; P = 0.04. CONCLUSION: Conservative oxygen therapy was associated with a statistically significant reduction in mortality at last follow-up compared to liberal oxygen therapy but the certainty of available evidence was low or very low due to bias, imprecision, and indirectness. PROSPERO REGISTRATION NUMBER: CRD42019138931.
AIM: The effect of conservative versus liberal oxygen therapy on mortality rates in post cardiac arrest patients is uncertain. METHODS: We undertook an individual patient data meta-analysis of patients randomised in clinical trials to conservative or liberal oxygen therapy after a cardiac arrest. The primary end point was mortality at last follow-up. RESULTS: Individual level patient data were obtained from seven randomised clinical trials with a total of 429 trial participants included. Four trials enrolled patients in the pre-hospital period. Of these, two provided protocol-directed oxygen therapy for 60 min, one provided it until the patient was handed over to the emergency department staff, and one provided it for a total of 72 h or until the patient was extubated. Three trials enrolled patients after intensive care unit (ICU) admission and generally continued protocolised oxygen therapy for a longer period, often until ICU discharge. A total of 90 of 221 patients (40.7%) assigned to conservative oxygen therapy and 103 of 206 patients (50%) assigned to liberal oxygen therapy had died by this last point of follow-up; absolute difference; odds ratio (OR) adjusted for study only; 0.67; 95% CI 0.45 to 0.99; P = 0.045; adjusted OR, 0.58; 95% CI 0.35 to 0.96; P = 0.04. CONCLUSION: Conservative oxygen therapy was associated with a statistically significant reduction in mortality at last follow-up compared to liberal oxygen therapy but the certainty of available evidence was low or very low due to bias, imprecision, and indirectness. PROSPERO REGISTRATION NUMBER: CRD42019138931.
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