Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial)
© 2018 Elsevier B.V. Introduction: Recent studies suggest the administration of 100% oxygen to hyperoxic levels following return-of-spontaneous-circulation (ROSC) post-cardiac arrest may be harmful. However, the feasibility and safety of oxygen titration in the prehospital setting is unknown. We con...
| Main Authors: | , , , , , , , , |
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| Format: | Journal Article |
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Elsevier
2018
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| Online Access: | http://hdl.handle.net/20.500.11937/69132 |
| _version_ | 1848761975441457152 |
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| author | Bray, Janet Hein, C. Smith, K. Stephenson, M. Grantham, H. Finn, Judith Stub, D. Cameron, P. Bernard, S. |
| author_facet | Bray, Janet Hein, C. Smith, K. Stephenson, M. Grantham, H. Finn, Judith Stub, D. Cameron, P. Bernard, S. |
| author_sort | Bray, Janet |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | © 2018 Elsevier B.V. Introduction: Recent studies suggest the administration of 100% oxygen to hyperoxic levels following return-of-spontaneous-circulation (ROSC) post-cardiac arrest may be harmful. However, the feasibility and safety of oxygen titration in the prehospital setting is unknown. We conducted a multi-centre, phase-2 study testing whether prehospital titration of oxygen results in an equivalent number of patients arriving at hospital with oxygen saturations SpO2 = 94%. Methods: We enrolled unconscious adults with: sustained ROSC; initial shockable rhythm; an advanced airway; and an SpO2 = 95%. Initially (Sept 2015–March 2016) patients were randomised 1:1 to either 2 L/minute (L/min) oxygen (titrated) or >10 L/min oxygen (control) via a bag-valve reservoir. However, one site experienced a high number of desaturations (SpO2 < 94%) in the titrated arm and this arm was changed (April 2016) to an initial reduction of oxygen to 4 L/min then, if tolerated, to 2 L/min, and the desaturation limit was decreased to <90%. Results: We randomised 61 patients to titrated (n = 37: 2L/min = 20 and 2–4 L/min = 17) oxygen or control (n = 24). Patients allocated to titrated oxygen were more likely to desaturate compared to controls ((SpO2 < 94%: 43% vs. 4%, p = 0.001; SpO2 < 90%: 19% vs. 4%, p = 0.09). The majority of desaturations (81%) occurred at 2L/min. On arrival at hospital the majority of patients had a SpO2 = 94% (titrated: 90% vs. control: 100%) and all patients had a SpO2 = 90%. One patient (control) re-arrested. Survival to hospital discharge was similar. Conclusion: Oxygen titration post-ROSC is feasible in the prehospital environment, but incremental titration commencing at 4L/min oxygen flow may be needed to maintain an oxygen saturation >90% (NCT02499042). |
| first_indexed | 2025-11-14T10:40:13Z |
| format | Journal Article |
| id | curtin-20.500.11937-69132 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T10:40:13Z |
| publishDate | 2018 |
| publisher | Elsevier |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-691322020-06-15T03:43:40Z Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial) Bray, Janet Hein, C. Smith, K. Stephenson, M. Grantham, H. Finn, Judith Stub, D. Cameron, P. Bernard, S. © 2018 Elsevier B.V. Introduction: Recent studies suggest the administration of 100% oxygen to hyperoxic levels following return-of-spontaneous-circulation (ROSC) post-cardiac arrest may be harmful. However, the feasibility and safety of oxygen titration in the prehospital setting is unknown. We conducted a multi-centre, phase-2 study testing whether prehospital titration of oxygen results in an equivalent number of patients arriving at hospital with oxygen saturations SpO2 = 94%. Methods: We enrolled unconscious adults with: sustained ROSC; initial shockable rhythm; an advanced airway; and an SpO2 = 95%. Initially (Sept 2015–March 2016) patients were randomised 1:1 to either 2 L/minute (L/min) oxygen (titrated) or >10 L/min oxygen (control) via a bag-valve reservoir. However, one site experienced a high number of desaturations (SpO2 < 94%) in the titrated arm and this arm was changed (April 2016) to an initial reduction of oxygen to 4 L/min then, if tolerated, to 2 L/min, and the desaturation limit was decreased to <90%. Results: We randomised 61 patients to titrated (n = 37: 2L/min = 20 and 2–4 L/min = 17) oxygen or control (n = 24). Patients allocated to titrated oxygen were more likely to desaturate compared to controls ((SpO2 < 94%: 43% vs. 4%, p = 0.001; SpO2 < 90%: 19% vs. 4%, p = 0.09). The majority of desaturations (81%) occurred at 2L/min. On arrival at hospital the majority of patients had a SpO2 = 94% (titrated: 90% vs. control: 100%) and all patients had a SpO2 = 90%. One patient (control) re-arrested. Survival to hospital discharge was similar. Conclusion: Oxygen titration post-ROSC is feasible in the prehospital environment, but incremental titration commencing at 4L/min oxygen flow may be needed to maintain an oxygen saturation >90% (NCT02499042). 2018 Journal Article http://hdl.handle.net/20.500.11937/69132 10.1016/j.resuscitation.2018.04.019 Elsevier restricted |
| spellingShingle | Bray, Janet Hein, C. Smith, K. Stephenson, M. Grantham, H. Finn, Judith Stub, D. Cameron, P. Bernard, S. Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial) |
| title | Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial) |
| title_full | Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial) |
| title_fullStr | Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial) |
| title_full_unstemmed | Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial) |
| title_short | Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial) |
| title_sort | oxygen titration after resuscitation from out-of-hospital cardiac arrest: a multi-centre, randomised controlled pilot study (the exact pilot trial) |
| url | http://hdl.handle.net/20.500.11937/69132 |