Abstract 14326: Post-Resuscitation Hyperoxia and Hypoxia Are Associated With Increased Cardiac Arrest Mortality
Introduction: Prior studies have examined the associations between hyperoxia, hypoxia and survival after cardiac arrest, with conflicting results.
Hypothesis: In adult out-of-hospital cardiac arrests (OHCA), hyperoxia and hypoxia in first 24 hours after sustained return of spontaneous circulation (ROSC) are associated with increased hospital mortality.
Methods: We used multicenter data from the Resuscitation Outcomes Consortium, including all adult OHCA with sustained ROSC ≥1 hour after Emergency Department arrival. We excluded patients with no arterial blood gas (ABG) measurements. Using all ABG collected during the first 24 hours of hospitalization, we defined hyperoxia as PaO2 ≥300 mm Hg and hypoxia as PaO2 <60 mm Hg. We identified hyperoxia and hypoxia for the initial, final and any ABG. Using logistic regression, we fit a series of multivariable models evaluating the associations between hyperoxia and hypoxia and hospital mortality, adjusted for age, sex, witnessed arrest, bystander chest compressions, initial electrocardiogram rhythm and ROC clinical site.
Results: We analyzed 9,186 treated adult OHCA. Hospital mortality was 60.1% Patients received a median of 3 ABG measurements (IQR: 2-5). Mean time to first ABG was 1.9±2.8 hours. Initial, final and any hyperoxia occurred in 1,753 (19.1%), 551 (6.0%) and 2,465 (26.5%), respectively. Initial, final and any hypoxia occurred in 774 (8.1%), 705 (7.7%) and 1,743 (19.0%), respectively. Initial hyperoxia was not associated with hospital mortality. Final and any hyperoxia were associated with increased hospital mortality. (Table) Initial, final and any hypoxia were associated with increased hospital mortality.
Conclusions: In adult OHCA, initial hyperoxia is not associated with hospital mortality. Hyperoxia at other time points within the first 24 hours after ROSC is associated with increased mortality. Hypoxia at any time within the first 24 hours after ROSC is associated with increased mortality.
Author Disclosures: H.E. Wang: Research Grant; Significant; NIH. D. Prince: None. J.C. Rittenberger: Research Grant; Modest; Redhill Biopharma. Other; Modest; Travel to Asia TTM Conference 2015. S. Trzeciak: None. J. Elmer: Research Grant; Significant; NIH support: 5K12HL109068. N. Johnson: None. B. Grunau: None. D. Carlbom: None. I. Drennan: None. P. Kudenchuk: None. M.L. Weisfeldt: None. M.C. Kurz: None. M. Hansen: None. A. Idris: None. T.P. Aufderheide: Research Grant; Modest; ROC, NETT, NIH Director’s Transformative Research Award. Other; Modest; Volunteer to American Heart Assoication, National Academy of Medicine, and Citizen CPR Foundation. D. Griffiths: None. J. Jasti: None. S. May: None. J. Christenson: None.
- © 2016 by American Heart Association, Inc.