The impact of severe acidemia on neurologic outcome of cardiac arrest survivors undergoing therapeutic hypothermia

Ganga, Harsha V.; Kallur, Kamala Ramya; Patel, Nishant; Sawyer, Kelly N.; Gowd, Pampana; Nair, Sanjeev; Puppala, Venkata K.; Manandhi, Aswathnarayan R.; Gupta, Ankur V.; Lundbye, Justin

doi:10.1016/j.resuscitation.2013.07.006

Cited by 40 publications

(18 citation statements)

References 41 publications

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“…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]. Concerns related to higher PaCO 2 levels include increased cerebral oedema, respiratory acidosis and impaired right ventricular function, which may all contribute to poor outcomes [11–13]. …”

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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“…The pH data from this study are, of course, only hypothesis-generating, but raise the question as to whether something as simple as initial pH could represent a simple and easily available biomarker of survival likelihood. Published data suggest that lower presentation pH is associated with poorer neurological outcomes following cardiac arrest 24 25. pH, together with other clinical factors described here and elsewhere, may be able to contribute to a scoring scale for accurate prediction of survival and thereby act as a guide to decisions in relation to active interventions.…”

Section: Discussionmentioning

confidence: 57%

Predictors of inhospital mortality following out-of-hospital cardiac arrest: Insights from a single-centre consecutive case series

Whittaker

Lehal

Calver

et al. 2016

Postgraduate Medical Journal

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“…Though most trials focused on OHCA, some studies included IHCA in their analyses [17,24,27,28,37,41]. Others, which only included abstracts presented at national meetings, may also have included these patients though some did not specifically address this issue in their presentation.…”

Section: Methodsmentioning

confidence: 99%

A review of the utility of a hypothermia protocol in cardiac arrests due to non-shockable rhythms

Freund

Kaplan

2017

Cardiol J.

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The impact of severe acidemia on neurologic outcome of cardiac arrest survivors undergoing therapeutic hypothermia

Cited by 40 publications

References 41 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

Predictors of inhospital mortality following out-of-hospital cardiac arrest: Insights from a single-centre consecutive case series

A review of the utility of a hypothermia protocol in cardiac arrests due to non-shockable rhythms

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