Hyperoxia in post-cardiac arrest: friend or foe?

Llitjos, Jean-François; Cariou, Alain

doi:10.21037/jtd.2018.09.54

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…The restoration of systemic oxygenated blood flow after a prolonged period of hypoxia may trigger widespread reperfusion injury. A key mechanism of reperfusion injury is the generation of oxidants and free radicals [ 19 ], whose flux increases in proportion with the local PO 2 [ 20 – 22 ], implying an increased risk of oxidant-mediated damage at higher PO 2 during reperfusion [ 23 ]. In the setting of ECPR, the risk of hyperoxia is particularly elevated, due to the ease of oxygenating blood through the membrane oxygenator [ 5 , 12 ], and a few retrospective studies have indeed reported a negative impact of hyperoxia on survival after ECPR [ 13 , 14 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

Bonnemain

Ltaief

Roumy

et al. 2021

BMC Cardiovasc Disord

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Background High levels of arterial oxygen pressures (PaO2) have been associated with increased mortality in extracorporeal cardiopulmonary resuscitation (ECPR), but there is limited information regarding possible mechanisms linking hyperoxia and death in this setting, notably with respect to its hemodynamic consequences. We aimed therefore at evaluating a possible association between PaO2, circulatory failure and death during ECPR. Methods We retrospectively analyzed 44 consecutive cardiac arrest (CA) patients treated with ECPR to determine the association between the mean PaO2 over the first 24 h, arterial blood pressure, vasopressor and intravenous fluid therapies, mortality, and cause of deaths. Results Eleven patients (25%) survived to hospital discharge. The main causes of death were refractory circulatory shock (46%) and neurological damage (24%). Compared to survivors, non survivors had significantly higher mean 24 h PaO2 (306 ± 121 mmHg vs 164 ± 53 mmHg, p < 0.001), lower mean blood pressure and higher requirements in vasopressors and fluids, but displayed similar pulse pressure during the first 24 h (an index of native cardiac recovery). The mean 24 h PaO2 was significantly and positively correlated with the severity of hypotension and the intensity of vasoactive therapies. Patients dying from circulatory failure died after a median of 17 h, compared to a median of 58 h for patients dying from a neurological cause. Patients dying from neurological cause had better preserved blood pressure and lower vasopressor requirements. Conclusion In conclusion, hyperoxia is associated with increased mortality during ECPR, possibly by promoting circulatory collapse or delayed neurological damage.

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Section: Discussionmentioning

confidence: 99%

Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

Bonnemain

Ltaief

Roumy

et al. 2021

BMC Cardiovasc Disord

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“…The fraction of oxygen in the FGF to the device (FdO 2 ) is set to 50% at initiation, and adapted to target normoxemia (P POST-ML O 2 80 to 100 mmHg). Hyperoxemia, thus excessive FdO 2 and P POST-ML O 2 and their potential impact on ischemia-reperfusion injury and vascular tone 17 , 18 are avoided, even if, to date, no diriment data exist.…”

Section: Methodsmentioning

confidence: 99%

EISOR Delivery: Regional experience with sharing equipe, equipment & expertise to increase cDCD donor pool in time of pandemic

et al. 2022

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Donation after circulatory death (DCD) programs are expanding in Europe, in the attempt to expand donors pool. Even in controlled DCD donors, however, a protracted warm ischemia time occurring in the perimortem period might damage organs, making these unsuitable for transplantation. Implementing a strategy of extracorporeal interval support for organ retrieval (EISOR), a regional reperfusion with normothermic, oxygenated blood provides a physiologic environment allowing extensive assessment of potential grafts, and potentially promotes recovery of native function. Here we report the results of a multi-center retrospective cohort study including 29 Maastricht Category III controlled DCD donors undergoing extracorporeal support in a regional DCD/EISOR Training Center, and in the network of referring In-Training Centers, under the liaison of the regional Transplant Coordination Center during COVID-19 pandemic, between March 2020 and November 2021. The study aims to understand whether a mobile, experienced EISOR team implementing a consistent technique and sharing its equipe, expertise and equipment in a regional network of hospitals, might be effective and efficient in implementing the regional DCD program activity even in a highly stressed healthcare system.

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“…The restoration of systemic oxygenated blood ow after a prolonged period of hypoxia may trigger widespread reperfusion injury. A key mechanism of reperfusion injury is the generation of oxidants and free radicals (18), whose ux increases in proportion with the local PO 2 (19)(20)(21), implying an increased risk of oxidant-mediated damage at higher PO 2 during reperfusion (22). In the setting of ECPR, the risk of hyperoxia is particularly elevated, due to the ease of oxygenating blood through the membrane oxygenator (5,12), and a few retrospective studies have indeed reported a negative impact of hyperoxia on survival after ECPR (13,14,23).…”

Section: Discussionmentioning

confidence: 99%

Hyperoxia During Extracorporeal Cardiopulmonary Resuscitation for Refractory Cardiac Arrest Is Associated With Severe Circulatory Failure and Increased Mortality

Bonnemain

Ltaief

Roumy

et al. 2021

Preprint

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Background: High levels of arterial oxygen pressures (PaO2) have been associated with increased mortality in extracorporeal cardiopulmonary resuscitation (ECPR), but there is limited information regarding possible mechanisms linking hyperoxia and death in this setting, notably with respect to its hemodynamic consequences. We aimed therefore at evaluating a possible association between PaO2, circulatory failure and death during ECPR.Methods: We retrospectively analyzed 44 consecutive cardiac arrest (CA) patients treated with ECPR to determine the association between the mean PaO2 over the first 24h, arterial blood pressure, vasopressor and intravenous fluid therapies, mortality, and cause of deaths.Results: Eleven patients (25%) survived to hospital discharge. The main causes of death were refractory circulatory shock (46%) and neurological damage (24%). Compared to survivors, non survivors had significantly higher mean 24h PaO2 (306±121 mmHg vs 164±53 mmHg, p < 0.001), lower mean blood pressure and higher requirements in vasopressors and fluids, but displayed similar pulse pressure during the first 24h (an index of native cardiac recovery). The mean 24h PaO2 was significantly correlated with hypotension and vasoactive therapies. Patients dying from neurological cause had better preserved blood pressure and lower vasopressor requirements. Patients dying from circulatory failure died after a median of 17h, compared to a median of 58 h for patients dying from a neurological cause (OR 0.95, 95% CI 0.90–0.99, p = 0.001).Conclusion: In conclusion, hyperoxia is associated with increased mortality during ECPR, possibly by promoting circulatory collapse or delayed neurological damage.

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Hyperoxia in post-cardiac arrest: friend or foe?

Cited by 5 publications

References 23 publications

Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

EISOR Delivery: Regional experience with sharing equipe, equipment & expertise to increase cDCD donor pool in time of pandemic

Hyperoxia During Extracorporeal Cardiopulmonary Resuscitation for Refractory Cardiac Arrest Is Associated With Severe Circulatory Failure and Increased Mortality

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