Associations of long-term hyperoxemia, survival, and neurological outcomes in extracorporeal cardiopulmonary resuscitation patients undergoing targeted temperature management: A retrospective observational analysis of the SAVE-J Ⅱ study

IF 2.1 Q3 CRITICAL CARE MEDICINE Resuscitation plus Pub Date : 2024-11-20 DOI:10.1016/j.resplu.2024.100831

Tomoaki Takeda , Hayato Taniguchi , Hiroshi Honzawa , Takeru Abe , Ichiro Takeuchi , Akihiko Inoue , Toru Hifumi , Tetsuya Sakamoto , Yasuhiro Kuroda , the SAVE-J Ⅱ study group

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Abstract

Background

Extracorporeal cardiopulmonary resuscitation (ECPR) can improve survival rates and neurological outcomes of patients with out-of-hospital cardiac arrest (OHCA). High levels of partial pressure of arterial oxygen (PaO₂) negatively affect survival and neurological outcomes in patients with OHCA. However, research on associations of hyperoxemia with survival and neurological outcomes after ECPR remains limited, especially considering targeted temperature management (TTM) administration to patients. Additionally, few reports have examined the impact of hyperoxemia beyond 24 h. In this study, we aimed to examine the effect of prolonged hyperoxemia on survival and neurological outcomes after ECPR for OHCA in patients undergoing TTM.

Methods

We performed a secondary observational analysis of data from the SAVE-J Ⅱ study, a retrospective, multicenter registry study of ECPR of patients with OHCA. Data on arterial PaO₂ after ECPR for intensive care unit days 2–4 were collected and averaged. Patients were divided into two groups: hyperoxic (PaO₂ ≥ 300 mmHg) and non-hyperoxic (PaO₂ < 300 mmHg). Each variable was compared between the groups. Additionally, survival and mortality rates at discharge were compared, and factors associated with survival (primary outcome) and neurological outcomes (secondary outcome) at discharge were examined.

Results

The multivariate analysis for survival at discharge showed that age, initial ventricular fibrillation/ventricular tachycardia (VF/VT) waveform, P = 0.0004), and hyperoxemia were significant factors. For neurological outcomes at discharge, significant factors included age, initial VF/VT waveform, hemoglobin level at presentation, and hyperoxemia.

Conclusions

Prolonged hyperoxemia was significantly associated with worse survival and neurological outcomes after ECPR for OHCA in patients who underwent TTM.

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接受针对性体温管理的体外心肺复苏患者长期高氧血症、存活率和神经系统预后的相关性：SAVE-J Ⅱ研究的回顾性观察分析

背景体外心肺复苏（ECPR）可提高院外心脏骤停（OHCA）患者的存活率和神经功能预后。动脉血氧分压（PaO2）过高会对 OHCA 患者的存活率和神经功能预后产生负面影响。然而，有关高氧血症与 ECPR 后存活率和神经功能预后之间关系的研究仍然有限，尤其是考虑到对患者进行有针对性的体温管理 (TTM)。在本研究中，我们旨在研究接受 TTM 的 OHCA 患者进行 ECPR 后，长时间高氧血症对存活率和神经功能预后的影响。方法我们对 SAVE-J Ⅱ 研究的数据进行了二次观察分析，该研究是一项对 OHCA 患者进行 ECPR 的回顾性多中心登记研究。我们收集了重症监护室第 2-4 天 ECPR 后的动脉 PaO2 数据并取平均值。患者被分为两组：高氧组（PaO2 ≥ 300 mmHg）和非高氧组（PaO2 < 300 mmHg）。对两组的每个变量进行了比较。结果出院时存活率的多变量分析表明，年龄、初始室颤/室性心动过速（VF/VT）波形（P = 0.0004）和高氧血症是重要的影响因素。结论对于接受 TTM 的 OHCA 患者，长时间的高氧血症与 ECPR 后较差的存活率和神经功能预后显著相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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