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

Details

Serval ID
serval:BIB_41973BEC141E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality.
Journal
BMC cardiovascular disorders
Author(s)
Bonnemain J., Rusca M., Ltaief Z., Roumy A., Tozzi P., Oddo M., Kirsch M., Liaudet L.
ISSN
1471-2261 (Electronic)
ISSN-L
1471-2261
Publication state
Published
Issued date
14/11/2021
Peer-reviewed
Oui
Volume
21
Number
1
Pages
542
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Abstract
High levels of arterial oxygen pressures (PaO <sub>2</sub> ) 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 PaO <sub>2</sub> , circulatory failure and death during ECPR.
We retrospectively analyzed 44 consecutive cardiac arrest (CA) patients treated with ECPR to determine the association between the mean PaO <sub>2</sub> over the first 24 h, arterial blood pressure, vasopressor and intravenous fluid therapies, mortality, and cause of deaths.
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 PaO <sub>2</sub> (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 PaO <sub>2</sub> 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.
In conclusion, hyperoxia is associated with increased mortality during ECPR, possibly by promoting circulatory collapse or delayed neurological damage.
Keywords
Cardiac arrest, Extracorporeal cardiopulmonary resuscitation (ECPR), Hyperoxia, Veno-arterial membrane oxygenation (VA-ECMO)
Pubmed
Web of science
Open Access
Yes
Create date
03/12/2021 14:00
Last modification date
10/12/2021 7:39
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