Arterial carbon dioxide tension and outcome in patients admitted to the intensive care unit after cardiac arrest

Schneider, Antoine; Eastwood, Glenn M; Bellomo, Rinaldo; Bailey, Michael; Lipcsey, Miklós; Pilcher, David; Young, Paul; Stow, Peter; Santamaria, John; Stachowski, Edward; Suzuki, Satoshi; Woinarski, Nicholas; Pilcher, Janine

doi:10.1016/j.resuscitation.2013.02.014

Cited by 168 publications

(142 citation statements)

References 49 publications

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“…For the critical outcome of death (or failure to be discharged home), 1 very-low-quality cohort study 188 of 6881 patients (downgraded for very serious concerns about risk of bias and imprecision) showed hypocapnia (less than 4.7 kPa) was associated with a worse outcome.…”

Section: Hypocapniamentioning

confidence: 99%

See 1 more Smart Citation

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

557

125

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Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

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Section: Hypocapniamentioning

confidence: 99%

“…One study 188 with a total of 16 542 patients, showed no difference in outcome for patients ventilated to hypercapnia (Paco 2 greater than 6.0 kPa). One study 187 with a total of 850 patients showed a higher mean Paco 2 in survivors.…”

Section: Hypercapniamentioning

confidence: 99%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

557

125

View full text Add to dashboard Cite

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“…as an independent marker for poor neurologic function [17,18]. An independent relationship between duration of hypocapnia and poor functional results and symptomatic vasospasm was found in aneurismatic subarachnoid hemorrhage [19].…”

Section: Discussionmentioning

confidence: 99%

Can venous blood gas values be used instead of arterial blood gas values in respiratory alkalosis?

Kozacı¹,

Gungor²,

Ay³

et al. 2014

Turk J Bioch

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“…Hypocapnia following hyperventilation causes cerebral vasoconstriction and, based on some observational studies, it can certainly cause and/or worsen cerebral ischemia, worsen outcome, and cause injury to other organs in PCAS. [80][81][82][83] On the other hand, increased PaCO2 may cause further worsening of an elevated ICP by increasing the CBF. However, evidence of the effect of hypercapnia on outcome after ROSC is conflicting.…”

Section: Map Target Valuementioning

confidence: 99%

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

Nakashima

Hifumi

Kawakita

et al. 2017

Circ J

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The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia. We reviewed the literature and the latest research about the following issues and propose practical care recommendations. Issues are (1) prediction of TTM candidate on admission, (2) cerebral blood flow and metabolism and target value of them, (3) seizure management using continuous electroencephalography, (4) target value of hemodynamic stabilization and its method, (5) management and analysis of respiration, (6) sedation and its monitoring, (7) shivering control and its monitoring, and (8) glucose management. We hope to establish standards of neurocritical care to optimize brain function and produce a favorable neurologic outcome.

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Arterial carbon dioxide tension and outcome in patients admitted to the intensive care unit after cardiac arrest

Cited by 168 publications

References 49 publications

Part 4: Advanced Life Support

Part 4: Advanced Life Support

Can venous blood gas values be used instead of arterial blood gas values in respiratory alkalosis?

Critical Care Management Focused on Optimizing Brain Function After Cardiac Arrest

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