The association between hyperoxia and patient outcomes after cardiac arrest: analysis of a high-resolution database

Elmer, Jonathan; Scutella, Michael; Pullalarevu, Raghevesh; Wang, Bo; Vaghasia, Nishit; Trzeciak, Stephen; Rosario-Rivera, Bedda L.; Guyette, Francis X.; Rittenberger, Jon C.; Dezfulian, Cameron

doi:10.1007/s00134-014-3555-6

Cited by 167 publications

(131 citation statements)

References 35 publications

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“…[179][180][181][182][183] Two studies showed hyperoxia was worse than normoxia. 179,181 Three studies reported favorable neurologic outcome as CPC 1 or 2.…”

Section: Hyperoxia Versus Normoxiamentioning

confidence: 99%

“…182 Very-low-quality evidence (downgraded because of very serious bias and serious inconsistency, indirectness, confounding) from a single-center study of 184 ICU patients showed that oxygen exposure over first 24 hours of ventilation was not associated with outcome with unadjusted and adjusted outcomes (effect size cannot be estimated from data). 183 Two studies used surrogate measures of favorable neurologic outcome. Very-low-quality evidence (downgraded because of very serious bias and serious inconsistency, indirectness, confounding) from an observational study 179 showed worse independent functional survival at hospital discharge (hyperoxia versus normoxia, 124/1156 versus 245/1171 [29% versus 38%]; unadjusted OR, 0.45; 95% CI, 0.36-0.58).…”

Section: Hyperoxia Versus Normoxiamentioning

confidence: 99%

“…[179][180][181][183][184][185][186] Four studies showed hyperoxia worse than normoxia. 179,181,183,184 One study showed a worse outcome with hyperoxia versus normoxia based on the first ICU Pao 2 (in-hospital mortality 63% versus 45%; adjusted OR hyperoxia exposure, 1.8; 95% CI, 1.5-2.2). 179 Another study showed a 100 mm Hg increase in Pao 2 was associated with a 24% increase in mortality risk (OR, 1.24; 95% CI, 1.18-1.31).…”

Section: Hyperoxia Versus Normoxiamentioning

confidence: 99%

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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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“…[179][180][181][182][183] Two studies showed hyperoxia was worse than normoxia. 179,181 Three studies reported favorable neurologic outcome as CPC 1 or 2.…”

Section: Hyperoxia Versus Normoxiamentioning

confidence: 99%

Section: Hyperoxia Versus Normoxiamentioning

confidence: 99%

Section: Hyperoxia Versus Normoxiamentioning

confidence: 99%

See 1 more Smart Citation

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

557

125

View full text Add to dashboard Cite

show abstract

“…In brain strokes recent guidelines emphasize that oxygen should only be used in strokes in the presence of hypoxaemia for the same reasons [8]. In post-resuscitation adult patients, both out of hospital and in the ICU, hyperoxia seems to be linked to a worse outcome in terms of one's neurological state and risk of death [9,10]. Neonatal Resuscitation Program guidelines recommend initial resuscitation of asphyxiated term newborns with 21% oxygen due to higher neonatal mortality with high flow oxygen [11].…”

mentioning

confidence: 99%

Efficiency of goal-directed oxygen delivery in ICU patients

Jochmans

Vong

Rolin

et al. 2016

Anaesthesiol Intensive Ther

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Background: Current clinical practice guidelines promote a goal-directed approach for oxygen delivery with respect to SpO 2 objectives. We evaluated the efficiency of a strategy based on goal-directed O 2 delivery in the ICU. Methods: A group of 30 patients (Group 1) with a proven history of chronic obstructive pulmonary disease suffering from acute hypercarbic exacerbation was compared to 2 other groups of patients admitted for acute respiratory failure with no history of pulmonary disease: 30 patients requiring oxygen supply and/or non-invasive ventilation (Group 2) and 30 requiring invasive ventilation (Group 3). The delivery of oxygen was based on SpO 2 measurement: 88−94% for Group 1 and 90−96% for others. The time spent with an SpO 2 below, within and above the prescribed limits was collected. Conclusions: Goal-directed oxygen delivery based on SpO 2 objectives in ICU patients ensures that in only approximately 64% of the time, SpO 2 stays within the prescribed range.

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“…In an attempt to further inform this debate, in an article recently published in Intensive Care Medicine, Elmer and colleagues [6] presented a detailed and complex, retrospective statistical analysis of a comprehensive database of post-cardiac arrest patients from a single specialist institution in the US. Their principal and novel aim was to establish the strength of the association between the estimated cumulative exposure to hyperoxia in the first 24 h post-RoSC and three early outcome variables: survival to acute (first) hospital discharge, a basic measure of cognitive function in survivors at (first) hospital discharge, and the severity of multiple organ dysfunction at 24 h following RoSC.…”

mentioning

confidence: 99%