A systematic review and meta-analysis of the association between arterial carbon dioxide tension and outcomes after cardiac arrest

McKenzie, Nicole; Williams, Teresa A.; Tohira, Hideo; Ho, Kwok M.; Finn, Judith

doi:10.1016/j.resuscitation.2016.09.019

Cited by 60 publications

(39 citation statements)

References 37 publications

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“…In experimental studies, carbon dioxide seems to have anticonvulsive [7], anti-inflammatory and antioxidant properties [8], suggesting a protective role of PaCO 2 in the development of HIE. According to a recent meta-analysis of observational data, both hypocapnia and hypercapnia are associated with poor outcomes after cardiac arrest [9]. One randomised controlled trial with 83 patients found, on the contrary, that targeting mild hypercapnia (6.7–7.3 kPa) after cardiac arrest attenuated the increase of neuron-specific enolase (NSE) concentrations over time, suggesting a possible protective effect of mild hypercapnia against neurological injury [10].…”

Section: Introductionmentioning

confidence: 99%

Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial

Jakkula²,

et al. 2018

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PurposeWe assessed the effects of targeting low-normal or high-normal arterial carbon dioxide tension (PaCO2) and normoxia or moderate hyperoxia after out-of-hospital cardiac arrest (OHCA) on markers of cerebral and cardiac injury.MethodsUsing a 23 factorial design, we randomly assigned 123 patients resuscitated from OHCA to low-normal (4.5–4.7 kPa) or high-normal (5.8–6.0 kPa) PaCO2 and to normoxia (arterial oxygen tension [PaO2] 10–15 kPa) or moderate hyperoxia (PaO2 20–25 kPa) and to low-normal or high-normal mean arterial pressure during the first 36 h in the intensive care unit. Here we report the results of the low-normal vs. high-normal PaCO2 and normoxia vs. moderate hyperoxia comparisons. The primary endpoint was the serum concentration of neuron-specific enolase (NSE) 48 h after cardiac arrest. Secondary endpoints included S100B protein and cardiac troponin concentrations, continuous electroencephalography (EEG) and near-infrared spectroscopy (NIRS) results and neurologic outcome at 6 months.ResultsIn total 120 patients were included in the analyses. There was a clear separation in PaCO2 (p < 0.001) and PaO2 (p < 0.001) between the groups. The median (interquartile range) NSE concentration at 48 h was 18.8 µg/l (13.9–28.3 µg/l) in the low-normal PaCO2 group and 22.5 µg/l (14.2–34.9 µg/l) in the high-normal PaCO2 group, p = 0.400; and 22.3 µg/l (14.8–27.8 µg/l) in the normoxia group and 20.6 µg/l (14.2–34.9 µg/l) in the moderate hyperoxia group, p = 0.594). High-normal PaCO2 and moderate hyperoxia increased NIRS values. There were no differences in other secondary outcomes.ConclusionsBoth high-normal PaCO2 and moderate hyperoxia increased NIRS values, but the NSE concentration was unaffected.RegistrationClinicalTrials.gov, NCT02698917. Registered on January 26, 2016.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5453-9) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial

Jakkula²,

et al. 2018

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“…In recent years three possible physiological candidates have been investigated in several observational cohorts indicating better outcome with higher mean arterial pressure (MAP), moderately elevated partial pressure of oxygen (PaO 2 ) and mildly elevated partial pressure of carbon dioxide (PaCO 2 ) [2][3][4]. Other reports have indicated worse outcome with increasing doses of vasopressors, hypotension, hypocapnia, severe hypercapnia and severe hyperoxia [5][6][7]. Also, completely neutral reports have been published [8].…”

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confidence: 99%

Physiological interventions in cardiac arrest: passing the pilot phase

2018

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“…Based on the current data, the targets for patients undergoing mechanical ventilation include a PaCO 2 of 40 mm Hg (or an end‐tidal CO 2 of 35 mm Hg) and an oxygen saturation (SpO 2 ) >94%. A normal PaCO 2 (35–45 mm Hg) is shown to correlate with improved outcomes when compared to hypercapnia or hypocapnia 97–100 . Hypocapnia may lead to hypocapnia‐induced cerebral vasoconstriction and, in turn, cerebral hypoperfusion.…”

Section: Respiratory and Hemodynamicsmentioning

confidence: 99%

State‐of‐the‐art considerations in post‐arrest care

Sonnier

Rittenberger

2020

JACEP Open

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Cardiac arrest has a high rate of morbidity and mortality. Several advances in postcardiac arrest management can improve outcome, but are time-dependent, placing the emergency physician in a critical role to both recognize the need for and initiate therapy. We present a novel perspective of both the workup and therapeutic interventions geared toward the emergency physician during the first few hours of care. We describe how the immediate care of a post-cardiac arrest patient is resource intensive and requires simultaneous evaluation for the underlying cause and intensive management to prevent further end organ damage, particularly of the central nervous system.The goal of the initial focused assessment is to rapidly determine if any reversible causes of cardiac arrest are present and to intervene when possible. Interventions performed in this acute period are aimed at preventing additional brain injury through optimizing hemodynamics, providing ventilatory support, and by using therapeutic hypothermia when indicated. After the initial phase of care, disposition is guided by available resources and the clinician's judgment. Transfer to a specialized cardiac arrest center is prudent in centers that do not have significant support or experience in the care of these patients.

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A systematic review and meta-analysis of the association between arterial carbon dioxide tension and outcomes after cardiac arrest

Cited by 60 publications

References 37 publications

Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial

Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial

Physiological interventions in cardiac arrest: passing the pilot phase

State‐of‐the‐art considerations in post‐arrest care

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