Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial.
Details
State: Public
Version: Final published version
License: Not specified
Serval ID
serval:BIB_27D14E8464CA
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial.
Journal
Critical care
Working group(s)
TTM2 Trial collaborators
Contributor(s)
Bělohlávek J., Callaway C., Cariou A., Cronberg T., Erlinge D., Hovdenes J., Kirkegaard H., Levin H., Morgan MPG, Nordberg P., Oddo M., Rylander C., Storm C., Ullén S., Wise M.P., Rowan K., Harrison D., Mouncey P., Shankar-Hari M., Young D., Lange T., Palmér K., Karlsson U.B., Heissler S., Bass F., Myburgh J., Taylor C., Bellino A., Abel-All M., Finfer B., Koch C., Li Y., O'Connor A., Pilowsky J., Schneider T., Tippett A., Ady B., Broadley T., Brown A., Melgaard L., Morgan M., Singh V., Symons R., Becker K., Sante N., Saleova V., Zerzanova S., Sefir-Kribel S., Lübeck U., Carrara M., Fernando K., Mackle D., Navarra L., Riley J., Westerheim E., Flatebø M., Ceric A., Haxhija Z., Terling L., Bossmar L., Jergle L., Månsson H.H., Maillard S.A., Zagar A.V., Jodlauk C., Scrivens J., Ainscough K., Fahey C., Bellomo R., Peck L., Young H., Cheung W., Cross R., Hayes M., Jain N., Kol M., Shah A., Wagh A., Wong H., Eduardo Martinez F., Brinkerhoff G., Bush D., Stewart A., Aneman A., Lombardo L., McCanny P., Penketh J., Seppelt I., Gresham R., Lowrey J., Masters K., Whitehead C., Walsham J., Harward M., Mackay J., Meyer J., Saylor E., Venz E., Wetzig K., Stedman W., Ashelford A., Mar S., Tokumitsu M., Yarad E., Buscher H., Reynolds C., Udy A., Burrell A., Collins J., Gantner D., Martin V.E., Mccracken P., Nanjayya V., Richardson A.S., Young M., Ghosh A., Said S., Beer R., Hartig F., Helbok R., Klein S., Peer A., Creteur J., Durand D., Dupont M., Christiaens S., Claes C., Deckx S., Ferdinande B., Lenaerts S., Mullens W., Stroobants S., Theunissen E., Verhaert D., Šmíd O., Flaksa M., Kemlink D., Malík J., Otáhal M., Rulíšek J., Šíranec M., Stach Z., Valeriánová A., Zavadilova P., Solař M., Bánszky R., Červená J., Pařízková R.Č., Šimůnek L., Varhaník F., Karásek J., Strýček M., Grejs A., Christensen S., Juhl-Olsen P., Thomsen I.K., Østergaard L.G., Cao A., Dupland P., Gavaud A., Jaubert P., Jozwiak M., Marin N., Savary G., Deye N., Megarbane B., Mora P., Sutterlin L., Legriel S., Bellut H., Ferre A., Lacave G., Paul M., Lascarrou J.B., Canet E., Garret C., Miaihle A.F., Reignier J., Vignon P., Daix T., Desachy A., Evrard B., Francois B., Fedou A.L., Goudelin M., Leithner C., Nee J., Streitberger K.J., Bonatti G., Firpo I., Frisoni P., Iachi A., Maiani S., Mandelli M., Tarantino F., Barbieri A., Bertellini E., Giuliani E., Melegari G., Roman-Pognuz E., Berlot G., Lucangelo U., Macchini E., Aune V., Drægni T., Jacobsen S., Pieschke S., Rasmussen Å., Akselsen G.R., Langeland H., Bergum D., Erbe T.M., Klepstad P., Næss H.M., Olsen R.B., Skjelnes L.E., Holen M., Post J.I., Fanebust R., Sørensen L.H., Kårstad K.Å., Wickman C., Barnes C., Barry B., Beehre N., Dinsdale D., Edney S., Hunt A., Judd H., Latimer-Bell C., Lawrence C., Moore J., Olatunji S., Psirides A., Robinson C., Tietjens K., Wright J., Knight D., Birker B., Bowie D., Burke T., Closey D., Crombie R., Davidson N., Henderson S., Hitchings L., McKay J., Mehrtens J., Minto E., Morgan S., Morris A., Ritzemar-Carter J., Roberts J., Shaw G., Townend K., Heyden K.V., Ahlqvist M., Lindgren R.D., Eiving I., Martner P., Myhrman E., Ryding B., Düring J., Bergström M., Bohm M., Didriksson I., Frid P., Heimburg K., Larsson M., Lundberg O., Hau S.O., Schmidbauer S., Borgquist O., Adolfsson A., Bjärnroos A., Blennow-Nordström E., Dragancea I., Kander T., Lybeck A., Mattiasson G., Persson O., Rundgren M., Schrey S., Westhall E., Annborn M., Andertun S., Gustavsson N., Hassel L., Johnsson J., Nelderup M., Petersson H., Petersson J., Stafilidou F., Undén J., Antonsson F., Bergman G., Gamroth J., Meirik M., Rudolfsson K., Sandberg H., Thorsson M., Savolainen K., Hansbo M., Helliksson M., Nödtveidt B., Sanner J., Sem V., Lindquist C.S., Awad A., Börjesson A.S., Hedberg M., Henning M., Petersen P., Dahlberg E., Forshammar J., Svensson V., Wanecek M., Eskilsson H., Rodriguez-Santos D., Appelqvist Å., Jidbratt H., Johansson E., Kiszakiewicz L., Nilsson Å., Olsson S., Paulsson A., Stempel U., Thoren A., Persson S., Berglund I., Bergström E., Törnqvist C., Östman I., Rubertsson S., Larsson I.M., Söderman E., Wallin E., Wessbergh J., Halliday T., Engvall F., Ben-Hamouda N., Bernini A., Carron P.N., Eckert P., Favre E., Miroz J.P., Morelli P., Muller O., Novi J., Rosseti A., Schnorf M., Haenggi M., Levis A., Nansoz S., Roth Team M., Söll N., Schrag C., Alicajic M., Baier P., Dütschler J., Flügel D., Fässler E., Gamio-Veis R., Güpfert M., Hilpertshauser Y., Hägele-Link S., Kleger G.R., Krähenmann P., Mair M.E., Schai N., Strohmaier C., Tangl P., Zieglgänsberger D., Maggiorini M., Claus G., Consani-Vogel G., Imbach L., Kaiser S., Kleinert E.M., Garcia PDW, Cassina T., Agazzi P., Capelli B., Casso G., Regazzi M., Schlotterbeck H., Via G., Villa M., Brooks J., Cocks E., Cole J., Curtin J., Davies M., Davies R., Fernandez S., Highfield J., Hill H., Pennant L., Rose S., Thomas E., Williams A., McGuigan P., Haffey S., O'Neill A., Ward K., Bewley J., Chillingworth A., Cloake J., Cole L., Galvin H., Garland Z., Grimmer L., Gumbrill B., Howie L., Johnson R., Searles C., Skorko A., Sweet K., Taylor V., Webster D., Keeble T., Adams G., Aggarwal R.K., Cartwright J.A., Church S., Clesham G.J., Davies J.R., Farrell K., Gamma R., Harding J., Jagathesan R., Kabir A., Kelly P.A., Kittridge L., Maccaroni M., Maloney G., Mion M., Nain N., Nalgirkar R., Namjoshi G., Pepper S., Redman E., Sayer J., Solesbury A., Tang K.H., Urovi S., Waghmare K., Watson N., Webber T., Isherwood P., Bentley C., Bergin C., Carrera R., Clark A., Cooper L., Despy L., Dooley N., Ellis K., Fellows E., Goundry S., Harkett S., McGhee C., Neal A., Smith H., Snelson C., Spruce E., Whitehouse T., Yakoub K., Walden A., Bartley S., Bhuie P., Frise M., Jacques N., Keating L., Pogson D., Daly Z., Rose S., Bannard-Smith J., Quayle R., Chee N., Barratt N., Bowman K., Branney D., Howe E., Letts M., Pitts S., Vamplew L., Callaway C.W., Sprouse S.D., Doshi A.A., Fugate J., Headlee A.M., Wijdicks EFM
ISSN
1466-609X (Electronic)
ISSN-L
1364-8535
Publication state
Published
Issued date
21/10/2022
Peer-reviewed
Oui
Volume
26
Number
1
Pages
323
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Abstract
Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO <sub>2</sub> ) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO <sub>2</sub> with patients' outcome.
Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO <sub>2</sub> < 60 mmHg and severe hyperoxemia as PaO <sub>2</sub> > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months.
1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93-1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95-1.06). The time exposure, i.e., the area under the curve (PaO <sub>2</sub> -AUC), for hyperoxemia was significantly associated with mortality (p = 0.003).
In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients.
clinicaltrials.gov NCT02908308 , Registered September 20, 2016.
Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO <sub>2</sub> < 60 mmHg and severe hyperoxemia as PaO <sub>2</sub> > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months.
1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93-1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95-1.06). The time exposure, i.e., the area under the curve (PaO <sub>2</sub> -AUC), for hyperoxemia was significantly associated with mortality (p = 0.003).
In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients.
clinicaltrials.gov NCT02908308 , Registered September 20, 2016.
Keywords
Cardiac arrest, Hyperoxemia, Hypoxemia, Mortality, Neurological outcome
Pubmed
Open Access
Yes
Create date
24/10/2022 13:07
Last modification date
25/01/2024 7:32
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