Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge among Patients Resuscitated after Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial
Importance: The administration of a high fraction of oxygen following return of spontaneous circulation in out-of-hospital cardiac arrest may increase reperfusion brain injury. Objective: To determine whether targeting a lower oxygen saturation in the early phase of postresuscitation care for out-of...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
| Published: |
AMER MEDICAL ASSOC
2022
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| Subjects: | |
| Online Access: | http://purl.org/au-research/grants/nhmrc/1107509 http://hdl.handle.net/20.500.11937/93113 |
| _version_ | 1848765701364383744 |
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| author | Bernard, S.A. Bray, Janet Smith, K. Stephenson, M. Finn, Judith Grantham, H. Hein, C. Masters, S. Stub, D. Perkins, G.D. Dodge, N. Martin, C. Hopkins, S. Cameron, P. |
| author_facet | Bernard, S.A. Bray, Janet Smith, K. Stephenson, M. Finn, Judith Grantham, H. Hein, C. Masters, S. Stub, D. Perkins, G.D. Dodge, N. Martin, C. Hopkins, S. Cameron, P. |
| author_sort | Bernard, S.A. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Importance: The administration of a high fraction of oxygen following return of spontaneous circulation in out-of-hospital cardiac arrest may increase reperfusion brain injury. Objective: To determine whether targeting a lower oxygen saturation in the early phase of postresuscitation care for out-of-hospital cardiac arrest improves survival at hospital discharge. Design, Setting, and Participants: This multicenter, parallel-group, randomized clinical trial included unconscious adults with return of spontaneous circulation and a peripheral oxygen saturation (Spo2) of at least 95% while receiving 100% oxygen. The trial was conducted in 2 emergency medical services and 15 hospitals in Victoria and South Australia, Australia, between December 11, 2017, and August 11, 2020, with data collection from ambulance and hospital medical records (final follow-up date, August 25, 2021). The trial enrolled 428 of a planned 1416 patients. Interventions: Patients were randomized by paramedics to receive oxygen titration to achieve an oxygen saturation of either 90% to 94% (intervention; n = 216) or 98% to 100% (standard care; n = 212) until arrival in the intensive care unit. Main Outcomes and Measures: The primary outcome was survival to hospital discharge. There were 9 secondary outcomes collected, including hypoxic episodes (Spo2<90%) and prespecified serious adverse events, which included hypoxia with rearrest. Results: The trial was stopped early due to the COVID-19 pandemic. Of the 428 patients who were randomized, 425 were included in the primary analysis (median age, 65.5 years; 100 [23.5%] women) and all completed the trial. Overall, 82 of 214 patients (38.3%) in the intervention group survived to hospital discharge compared with 101 of 211 (47.9%) in the standard care group (difference, -9.6% [95% CI, -18.9% to -0.2%]; unadjusted odds ratio, 0.68 [95% CI, 0.46-1.00]; P =.05). Of the 9 prespecified secondary outcomes collected during hospital stay, 8 showed no significant difference. A hypoxic episode prior to intensive care was observed in 31.3% (n = 67) of participants in the intervention group and 16.1% (n = 34) in the standard care group (difference, 15.2% [95% CI, 7.2%-23.1%]; OR, 2.37 [95% CI, 1.49-3.79]; P <.001). Conclusions and Relevance: Among patients achieving return of spontaneous circulation after out-of-hospital cardiac arrest, targeting an oxygen saturation of 90% to 94%, compared with 98% to 100%, until admission to the intensive care unit did not significantly improve survival to hospital discharge. Although the trial is limited by early termination due to the COVID-19 pandemic, the findings do not support use of an oxygen saturation target of 90% to 94% in the out-of-hospital setting after resuscitation from cardiac arrest. Trial Registration: ClinicalTrials.gov Identifier: NCT03138005. |
| first_indexed | 2025-11-14T11:39:26Z |
| format | Journal Article |
| id | curtin-20.500.11937-93113 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:39:26Z |
| publishDate | 2022 |
| publisher | AMER MEDICAL ASSOC |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-931132023-09-18T08:00:48Z Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge among Patients Resuscitated after Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial Bernard, S.A. Bray, Janet Smith, K. Stephenson, M. Finn, Judith Grantham, H. Hein, C. Masters, S. Stub, D. Perkins, G.D. Dodge, N. Martin, C. Hopkins, S. Cameron, P. Science & Technology Life Sciences & Biomedicine Medicine, General & Internal General & Internal Medicine INTERNATIONAL LIAISON COMMITTEE AMERICAN-HEART-ASSOCIATION HEALTH-CARE PROFESSIONALS EUROPEAN RESUSCITATION STROKE FOUNDATION OUTCOME REPORTS TASK-FORCE HYPEROXIA METAANALYSIS COUNCIL Adult Humans Female Aged Male Out-of-Hospital Cardiac Arrest Cardiopulmonary Resuscitation Patient Discharge Oxygen Pandemics COVID-19 Oxygen Saturation Oxygen Inhalation Therapy Hospitals Victoria EXACT Investigators Humans Oxygen Cardiopulmonary Resuscitation Patient Discharge Oxygen Inhalation Therapy Adult Aged Hospitals Victoria Female Male Out-of-Hospital Cardiac Arrest Pandemics COVID-19 Oxygen Saturation Importance: The administration of a high fraction of oxygen following return of spontaneous circulation in out-of-hospital cardiac arrest may increase reperfusion brain injury. Objective: To determine whether targeting a lower oxygen saturation in the early phase of postresuscitation care for out-of-hospital cardiac arrest improves survival at hospital discharge. Design, Setting, and Participants: This multicenter, parallel-group, randomized clinical trial included unconscious adults with return of spontaneous circulation and a peripheral oxygen saturation (Spo2) of at least 95% while receiving 100% oxygen. The trial was conducted in 2 emergency medical services and 15 hospitals in Victoria and South Australia, Australia, between December 11, 2017, and August 11, 2020, with data collection from ambulance and hospital medical records (final follow-up date, August 25, 2021). The trial enrolled 428 of a planned 1416 patients. Interventions: Patients were randomized by paramedics to receive oxygen titration to achieve an oxygen saturation of either 90% to 94% (intervention; n = 216) or 98% to 100% (standard care; n = 212) until arrival in the intensive care unit. Main Outcomes and Measures: The primary outcome was survival to hospital discharge. There were 9 secondary outcomes collected, including hypoxic episodes (Spo2<90%) and prespecified serious adverse events, which included hypoxia with rearrest. Results: The trial was stopped early due to the COVID-19 pandemic. Of the 428 patients who were randomized, 425 were included in the primary analysis (median age, 65.5 years; 100 [23.5%] women) and all completed the trial. Overall, 82 of 214 patients (38.3%) in the intervention group survived to hospital discharge compared with 101 of 211 (47.9%) in the standard care group (difference, -9.6% [95% CI, -18.9% to -0.2%]; unadjusted odds ratio, 0.68 [95% CI, 0.46-1.00]; P =.05). Of the 9 prespecified secondary outcomes collected during hospital stay, 8 showed no significant difference. A hypoxic episode prior to intensive care was observed in 31.3% (n = 67) of participants in the intervention group and 16.1% (n = 34) in the standard care group (difference, 15.2% [95% CI, 7.2%-23.1%]; OR, 2.37 [95% CI, 1.49-3.79]; P <.001). Conclusions and Relevance: Among patients achieving return of spontaneous circulation after out-of-hospital cardiac arrest, targeting an oxygen saturation of 90% to 94%, compared with 98% to 100%, until admission to the intensive care unit did not significantly improve survival to hospital discharge. Although the trial is limited by early termination due to the COVID-19 pandemic, the findings do not support use of an oxygen saturation target of 90% to 94% in the out-of-hospital setting after resuscitation from cardiac arrest. Trial Registration: ClinicalTrials.gov Identifier: NCT03138005. 2022 Journal Article http://hdl.handle.net/20.500.11937/93113 10.1001/jama.2022.17701 English http://purl.org/au-research/grants/nhmrc/1107509 http://purl.org/au-research/grants/nhmrc/116453 http://purl.org/au-research/grants/nhmrc/1174838 http://purl.org/au-research/grants/nhmrc/1139686 AMER MEDICAL ASSOC unknown |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Medicine, General & Internal General & Internal Medicine INTERNATIONAL LIAISON COMMITTEE AMERICAN-HEART-ASSOCIATION HEALTH-CARE PROFESSIONALS EUROPEAN RESUSCITATION STROKE FOUNDATION OUTCOME REPORTS TASK-FORCE HYPEROXIA METAANALYSIS COUNCIL Adult Humans Female Aged Male Out-of-Hospital Cardiac Arrest Cardiopulmonary Resuscitation Patient Discharge Oxygen Pandemics COVID-19 Oxygen Saturation Oxygen Inhalation Therapy Hospitals Victoria EXACT Investigators Humans Oxygen Cardiopulmonary Resuscitation Patient Discharge Oxygen Inhalation Therapy Adult Aged Hospitals Victoria Female Male Out-of-Hospital Cardiac Arrest Pandemics COVID-19 Oxygen Saturation Bernard, S.A. Bray, Janet Smith, K. Stephenson, M. Finn, Judith Grantham, H. Hein, C. Masters, S. Stub, D. Perkins, G.D. Dodge, N. Martin, C. Hopkins, S. Cameron, P. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge among Patients Resuscitated after Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial |
| title | Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge among Patients Resuscitated after Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial |
| title_full | Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge among Patients Resuscitated after Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial |
| title_fullStr | Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge among Patients Resuscitated after Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial |
| title_full_unstemmed | Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge among Patients Resuscitated after Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial |
| title_short | Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge among Patients Resuscitated after Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial |
| title_sort | effect of lower vs higher oxygen saturation targets on survival to hospital discharge among patients resuscitated after out-of-hospital cardiac arrest: the exact randomized clinical trial |
| topic | Science & Technology Life Sciences & Biomedicine Medicine, General & Internal General & Internal Medicine INTERNATIONAL LIAISON COMMITTEE AMERICAN-HEART-ASSOCIATION HEALTH-CARE PROFESSIONALS EUROPEAN RESUSCITATION STROKE FOUNDATION OUTCOME REPORTS TASK-FORCE HYPEROXIA METAANALYSIS COUNCIL Adult Humans Female Aged Male Out-of-Hospital Cardiac Arrest Cardiopulmonary Resuscitation Patient Discharge Oxygen Pandemics COVID-19 Oxygen Saturation Oxygen Inhalation Therapy Hospitals Victoria EXACT Investigators Humans Oxygen Cardiopulmonary Resuscitation Patient Discharge Oxygen Inhalation Therapy Adult Aged Hospitals Victoria Female Male Out-of-Hospital Cardiac Arrest Pandemics COVID-19 Oxygen Saturation |
| url | http://purl.org/au-research/grants/nhmrc/1107509 http://purl.org/au-research/grants/nhmrc/1107509 http://purl.org/au-research/grants/nhmrc/1107509 http://purl.org/au-research/grants/nhmrc/1107509 http://hdl.handle.net/20.500.11937/93113 |