Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest

Bellomo, Rinaldo, Bailey, Michael, Eastwood, Glenn M., Nichol, Alistair, Pilcher, David, Hart, Graeme K., Reade, Michael C., Egi, Moritoki and Cooper, D. James (2011) Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest. Critical Care, 15 2: . doi:10.1186/cc10090


Author Bellomo, Rinaldo
Bailey, Michael
Eastwood, Glenn M.
Nichol, Alistair
Pilcher, David
Hart, Graeme K.
Reade, Michael C.
Egi, Moritoki
Cooper, D. James
Title Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest
Journal name Critical Care   Check publisher's open access policy
ISSN 1364-8535
1466-609X
Publication date 2011-03-08
Sub-type Article (original research)
DOI 10.1186/cc10090
Open Access Status DOI
Volume 15
Issue 2
Total pages 9
Place of publication Philadelphia, PA, United States
Publisher Current Science
Language eng
Formatted abstract
Introduction: Hyperoxia has recently been reported as an independent risk factor for mortality in patients resuscitated from cardiac arrest. We examined the independent relationship between hyperoxia and outcomes in such patients.

Methods:
We divided patients resuscitated from nontraumatic cardiac arrest from 125 intensive care units (ICUs) into three groups according to worst PaO2 level or alveolar-arterial O2 gradient in the first 24 hours after admission. We defined 'hyperoxia' as PaO2 of 300 mmHg or greater, 'hypoxia/poor O2 transfer' as either PaO2 < 60 mmHg or ratio of PaO2 to fraction of inspired oxygen (FiO2 ) < 300, 'normoxia' as any value between hypoxia and hyperoxia and 'isolated hypoxemia' as PaO2 < 60 mmHg regardless of FiO2. Mortality at hospital discharge was the main outcome measure.

Results: Of 12,108 total patients, 1,285 (10.6%) had hyperoxia, 8,904 (73.5%) had hypoxia/poor O2 transfer, 1,919 (15.9%) had normoxia and 1,168 (9.7%) had isolated hypoxemia (PaO2 < 60 mmHg). The hyperoxia group had higher mortality (754 (59%) of 1,285 patients; 95% confidence interval (95% CI), 56% to 61%) than the normoxia group (911 (47%) of 1,919 patients; 95% CI, 45% to 50%) with a proportional difference of 11% (95% CI, 8% to 15%), but not higher than the hypoxia group (5,303 (60%) of 8,904 patients; 95% CI, 59% to 61%). In a multivariable model controlling for some potential confounders, including illness severity, hyperoxia had an odds ratio for hospital death of 1.2 (95% CI, 1.1 to 1.6). However, once we applied Cox proportional hazards modelling of survival, sensitivity analyses using deciles of hypoxemia, time period matching and hyperoxia defined as PaO2 > 400 mmHg, hyperoxia had no independent association with mortality. Importantly, after adjustment for FiO2 and the relevant covariates, PaO2 was no longer predictive of hospital mortality (P = 0.21).

Conclusions: Among patients admitted to the ICU after cardiac arrest, hyperoxia did not have a robust or consistently reproducible association with mortality. We urge caution in implementing policies of deliberate decreases in FiO2 in these patients.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Article number R90

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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