Association Between Early Hyperoxia Exposure After Resuscitation From Cardiac Arrest and Neurological Disability

Prospective Multicenter Protocol-Directed Cohort Study

Brian W. Roberts, J. Hope Kilgannon, Benton Hunter, Michael A. Puskarich, Lisa Pierce, Michael Donnino, Marion Leary, Jeffrey Kline, Alan E. Jones, Nathan I. Shapiro, Benjamin S. Abella, Stephen Trzeciak

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

BACKGROUND: Studies examining the association between hyperoxia exposure after resuscitation from cardiac arrest and clinical outcomes have reported conflicting results. Our objective was to test the hypothesis that early postresuscitation hyperoxia is associated with poor neurological outcome. METHODS: This was a multicenter prospective cohort study. We included adult patients with cardiac arrest who were mechanically ventilated and received targeted temperature management after return of spontaneous circulation. We excluded patients with cardiac arrest caused by trauma or sepsis. Per protocol, partial pressure of arterial oxygen (Pao2) was measured at 1 and 6 hours after return of spontaneous circulation. Hyperoxia was defined as a Pao2 >300 mm Hg during the initial 6 hours after return of spontaneous circulation. The primary outcome was poor neurological function at hospital discharge, defined as a modified Rankin Scale score >3. Multivariable generalized linear regression with a log link was used to test the association between Pao2 and poor neurological outcome. To assess whether there was an association between other supranormal Pao2 levels and poor neurological outcome, we used other Pao2 cut points to define hyperoxia (ie, 100, 150, 200, 250, 350, 400 mm Hg). RESULTS: Of the 280 patients included, 105 (38%) had exposure to hyperoxia. Poor neurological function at hospital discharge occurred in 70% of patients in the entire cohort and in 77% versus 65% among patients with versus without exposure to hyperoxia respectively (absolute risk difference, 12%; 95% confidence interval, 1-23). Hyperoxia was independently associated with poor neurological function (relative risk, 1.23; 95% confidence interval, 1.11-1.35). On multivariable analysis, a 1-hour-longer duration of hyperoxia exposure was associated with a 3% increase in risk of poor neurological outcome (relative risk, 1.03; 95% confidence interval, 1.02-1.05). We found that the association with poor neurological outcome began at ≥300 mm Hg. CONCLUSIONS: Early hyperoxia exposure after resuscitation from cardiac arrest was independently associated with poor neurological function at hospital discharge.

Original languageEnglish (US)
Pages (from-to)2114-2124
Number of pages11
JournalCirculation
Volume137
Issue number20
DOIs
StatePublished - May 15 2018

Fingerprint

Hyperoxia
Heart Arrest
Resuscitation
Cohort Studies
Confidence Intervals
Partial Pressure
Linear Models
Sepsis
Prospective Studies
Oxygen
Temperature

Keywords

  • brain injuries
  • heart arrest
  • hyperoxia
  • nervous system

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Association Between Early Hyperoxia Exposure After Resuscitation From Cardiac Arrest and Neurological Disability : Prospective Multicenter Protocol-Directed Cohort Study. / Roberts, Brian W.; Kilgannon, J. Hope; Hunter, Benton; Puskarich, Michael A.; Pierce, Lisa; Donnino, Michael; Leary, Marion; Kline, Jeffrey; Jones, Alan E.; Shapiro, Nathan I.; Abella, Benjamin S.; Trzeciak, Stephen.

In: Circulation, Vol. 137, No. 20, 15.05.2018, p. 2114-2124.

Research output: Contribution to journalArticle

Roberts, BW, Kilgannon, JH, Hunter, B, Puskarich, MA, Pierce, L, Donnino, M, Leary, M, Kline, J, Jones, AE, Shapiro, NI, Abella, BS & Trzeciak, S 2018, 'Association Between Early Hyperoxia Exposure After Resuscitation From Cardiac Arrest and Neurological Disability: Prospective Multicenter Protocol-Directed Cohort Study', Circulation, vol. 137, no. 20, pp. 2114-2124. https://doi.org/10.1161/CIRCULATIONAHA.117.032054
Roberts, Brian W. ; Kilgannon, J. Hope ; Hunter, Benton ; Puskarich, Michael A. ; Pierce, Lisa ; Donnino, Michael ; Leary, Marion ; Kline, Jeffrey ; Jones, Alan E. ; Shapiro, Nathan I. ; Abella, Benjamin S. ; Trzeciak, Stephen. / Association Between Early Hyperoxia Exposure After Resuscitation From Cardiac Arrest and Neurological Disability : Prospective Multicenter Protocol-Directed Cohort Study. In: Circulation. 2018 ; Vol. 137, No. 20. pp. 2114-2124.
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abstract = "BACKGROUND: Studies examining the association between hyperoxia exposure after resuscitation from cardiac arrest and clinical outcomes have reported conflicting results. Our objective was to test the hypothesis that early postresuscitation hyperoxia is associated with poor neurological outcome. METHODS: This was a multicenter prospective cohort study. We included adult patients with cardiac arrest who were mechanically ventilated and received targeted temperature management after return of spontaneous circulation. We excluded patients with cardiac arrest caused by trauma or sepsis. Per protocol, partial pressure of arterial oxygen (Pao2) was measured at 1 and 6 hours after return of spontaneous circulation. Hyperoxia was defined as a Pao2 >300 mm Hg during the initial 6 hours after return of spontaneous circulation. The primary outcome was poor neurological function at hospital discharge, defined as a modified Rankin Scale score >3. Multivariable generalized linear regression with a log link was used to test the association between Pao2 and poor neurological outcome. To assess whether there was an association between other supranormal Pao2 levels and poor neurological outcome, we used other Pao2 cut points to define hyperoxia (ie, 100, 150, 200, 250, 350, 400 mm Hg). RESULTS: Of the 280 patients included, 105 (38{\%}) had exposure to hyperoxia. Poor neurological function at hospital discharge occurred in 70{\%} of patients in the entire cohort and in 77{\%} versus 65{\%} among patients with versus without exposure to hyperoxia respectively (absolute risk difference, 12{\%}; 95{\%} confidence interval, 1-23). Hyperoxia was independently associated with poor neurological function (relative risk, 1.23; 95{\%} confidence interval, 1.11-1.35). On multivariable analysis, a 1-hour-longer duration of hyperoxia exposure was associated with a 3{\%} increase in risk of poor neurological outcome (relative risk, 1.03; 95{\%} confidence interval, 1.02-1.05). We found that the association with poor neurological outcome began at ≥300 mm Hg. CONCLUSIONS: Early hyperoxia exposure after resuscitation from cardiac arrest was independently associated with poor neurological function at hospital discharge.",
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AU - Puskarich, Michael A.

AU - Pierce, Lisa

AU - Donnino, Michael

AU - Leary, Marion

AU - Kline, Jeffrey

AU - Jones, Alan E.

AU - Shapiro, Nathan I.

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N2 - BACKGROUND: Studies examining the association between hyperoxia exposure after resuscitation from cardiac arrest and clinical outcomes have reported conflicting results. Our objective was to test the hypothesis that early postresuscitation hyperoxia is associated with poor neurological outcome. METHODS: This was a multicenter prospective cohort study. We included adult patients with cardiac arrest who were mechanically ventilated and received targeted temperature management after return of spontaneous circulation. We excluded patients with cardiac arrest caused by trauma or sepsis. Per protocol, partial pressure of arterial oxygen (Pao2) was measured at 1 and 6 hours after return of spontaneous circulation. Hyperoxia was defined as a Pao2 >300 mm Hg during the initial 6 hours after return of spontaneous circulation. The primary outcome was poor neurological function at hospital discharge, defined as a modified Rankin Scale score >3. Multivariable generalized linear regression with a log link was used to test the association between Pao2 and poor neurological outcome. To assess whether there was an association between other supranormal Pao2 levels and poor neurological outcome, we used other Pao2 cut points to define hyperoxia (ie, 100, 150, 200, 250, 350, 400 mm Hg). RESULTS: Of the 280 patients included, 105 (38%) had exposure to hyperoxia. Poor neurological function at hospital discharge occurred in 70% of patients in the entire cohort and in 77% versus 65% among patients with versus without exposure to hyperoxia respectively (absolute risk difference, 12%; 95% confidence interval, 1-23). Hyperoxia was independently associated with poor neurological function (relative risk, 1.23; 95% confidence interval, 1.11-1.35). On multivariable analysis, a 1-hour-longer duration of hyperoxia exposure was associated with a 3% increase in risk of poor neurological outcome (relative risk, 1.03; 95% confidence interval, 1.02-1.05). We found that the association with poor neurological outcome began at ≥300 mm Hg. CONCLUSIONS: Early hyperoxia exposure after resuscitation from cardiac arrest was independently associated with poor neurological function at hospital discharge.

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