High Normocapnia and Better Functional Outcome in Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation After Out-of-Hospital Cardiac Arrest.

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE Chest Pub Date : 2025-01-19 DOI:10.1016/j.chest.2025.01.010
Junichi Izawa, Shunsuke Kimata, Sho Komukai, Masashi Okubo, Akihiro Sakai, Tetsuhisa Kitamura, Yutaka Yamaguchi
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Abstract

Background: The optimal target for partial pressure of arterial carbon dioxide (PaCO₂) remains uncertain in patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) following out-of-hospital cardiac arrest (OHCA).

Research question: Are PaCO₂ levels associated with functional outcomes in patients receiving VA-ECMO after OHCA?

Study design: and Methods: This multicenter, registry-based observational study, conducted from 2014 to 2020, included non-traumatic adult OHCA patients on VA-ECMO with PaCO₂ levels measured within six hours of initiation (initial PaCO₂ set) and at 18-30 hours post-initiation (24-hour PaCO₂ set). PaCO₂ levels were categorized into five groups: hypocapnia (<30 mmHg), low normocapnia (30-<40 mmHg), high normocapnia (40-<50 mmHg), mild hypercapnia (50-<60 mmHg), and moderate to severe hypercapnia (≥60 mmHg). The primary outcome was the favorable functional outcome at 30 days, analyzed using multivariable logistic regression. PaCO₂ trajectories from initial to 24-hour levels were also explored.

Results: A total of 1,454 and 572 patients were analyzed in the initial and 24-hour PaCO₂ sets, respectively. Compared to high normocapnia, low normocapnia was associated with worse functional outcomes in both initial and 24-hour PaCO₂ analyses, with adjusted odds ratios of 0.59 (95% CI, 0.38-0.89) for initial low normocapnia and 0.56 (95% CI, 0.33-0.95) for 24-hour low normocapnia. Other categories were similarly associated with worse functional outcomes in both PaCO₂ analyses. In exploratory analyses, trajectories ending in high normocapnia demonstrated higher proportions of the favorable functional outcome than those ending in low normocapnia, regardless of initial PaCO₂ levels.

Interpretation: In non-traumatic adult OHCA patients on VA-ECMO, high normocapnia was associated with better functional outcomes than low normocapnia in both initial and 24-hour PaCO₂ analyses. These findings suggest a hypothesis that maintaining high normocapnia levels, irrespective of initial PaCO2, may improve functional outcomes for patients on VA-ECMO after OHCA.

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院外心脏骤停后接受静脉-动脉体外膜氧合的患者高正碳酸血症和更好的功能结局
背景:院外心脏骤停(OHCA)后接受静脉-动脉体外膜氧合(VA-ECMO)的患者动脉二氧化碳分压(PaCO₂)的最佳目标仍不确定。研究问题:PaCO₂水平与OHCA后接受VA-ECMO患者的功能结局相关吗?研究设计和方法:这项多中心、基于登记的观察性研究于2014年至2020年进行,纳入了采用VA-ECMO的非创伤性成年OHCA患者,他们在开始治疗6小时内(初始PaCO₂设置)和开始治疗后18-30小时(24小时PaCO₂设置)测量PaCO₂水平。PaCO₂水平分为5组:低碳酸血症(结果:在初始PaCO₂设置和24小时PaCO₂设置中,分别分析了1454名和572名患者。在初始和24小时PaCO 2分析中,与高正肌酸相比,低正肌酸与更差的功能结果相关,初始低正肌酸的调整优势比为0.59 (95% CI, 0.38-0.89), 24小时低正肌酸的调整优势比为0.56 (95% CI, 0.33-0.95)。在两种PaCO₂分析中,其他类别与较差的功能结果相似。在探索性分析中,无论初始PaCO₂水平如何,以高正肌氧饱和度结束的轨迹比低正肌氧饱和度结束的轨迹显示出更高比例的良好功能预后。解释:在VA-ECMO的非创伤性成年OHCA患者中,在初始和24小时PaCO 2分析中,高正常肌氧饱和度比低正常肌氧饱和度具有更好的功能结局。这些发现提出了一种假设,即维持高的正肌钙水平,而不考虑初始PaCO2,可能会改善OHCA后VA-ECMO患者的功能结局。
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IF 0 Research Handbook on Natural Law TheoryPub Date : 1900-01-01 DOI: 10.1093/acprof:oso/9780199208982.001.0001
Beatrice Groves
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Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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