Non-linear association between arterial oxygen tension and survival after out-of-hospital cardiac arrest: A multicentre observational study
Background: Studies to identify safe oxygenation targets after out-of-hospital cardiac arrest (OHCA) have often assumed a linear relationship between arterial oxygen tension (PaO2) and survival, or have dichotomised PaO2 at a supra-physiological level. We hypothesised that abnormalities in mean PaO2...
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| Format: | Journal Article |
| Language: | English |
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ELSEVIER IRELAND LTD
2021
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| Online Access: | http://hdl.handle.net/20.500.11937/93462 |
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| author | McKenzie, Nicole Finn, Judith Dobb, G. Bailey, P. Arendts, G. Celenza, A. Fatovich, D. Jenkins, I. Ball, Stephen Bray, Janet Ho, K.M. |
| author_facet | McKenzie, Nicole Finn, Judith Dobb, G. Bailey, P. Arendts, G. Celenza, A. Fatovich, D. Jenkins, I. Ball, Stephen Bray, Janet Ho, K.M. |
| author_sort | McKenzie, Nicole |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background: Studies to identify safe oxygenation targets after out-of-hospital cardiac arrest (OHCA) have often assumed a linear relationship between arterial oxygen tension (PaO2) and survival, or have dichotomised PaO2 at a supra-physiological level. We hypothesised that abnormalities in mean PaO2 (both high and low) would be associated with decreased survival after OHCA. Methods: We conducted a retrospective multicentre cohort study of adult OHCA patients who received mechanical ventilation on admission to the intensive care unit (ICU). The potential non-linear relationship between the mean PaO2 within the first 24 -hs of ICU admission and survival to hospital discharge (STHD) was assessed by a four-knot restricted cubic spline function with adjustment for potential confounders. Results: 3764 arterial blood gas results were available for 491 patients in the first 24-hs of ICU admission. The relationship between mean PaO2 over the first 24-hs and STHD was an inverted U-shape, with highest survival for those with a mean PaO2 between 100 and 180 mmHg (reference category) compared to a mean PaO2 of <100 mmHg (adjusted odds ratio [aOR] 0.50 95% confidence interval [CI] 0.30, 0.84), or >180 mmHg (aOR 0.41, 95% CI 0.18, 0.92). Mean PaO2 within 24 -hs was the third most important predictor and explained 9.1% of the variability in STHD. Conclusion: The mean PaO2 within the first 24-hs after admission for OHCA has a non-linear association with the highest STHD seen between 100 and 180 mmHg. Randomised controlled trials are now needed to validate the optimal oxygenation targets in mechanically ventilated OHCA patients. |
| first_indexed | 2025-11-14T11:39:59Z |
| format | Journal Article |
| id | curtin-20.500.11937-93462 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:39:59Z |
| publishDate | 2021 |
| publisher | ELSEVIER IRELAND LTD |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-934622023-10-25T07:40:42Z Non-linear association between arterial oxygen tension and survival after out-of-hospital cardiac arrest: A multicentre observational study McKenzie, Nicole Finn, Judith Dobb, G. Bailey, P. Arendts, G. Celenza, A. Fatovich, D. Jenkins, I. Ball, Stephen Bray, Janet Ho, K.M. Science & Technology Life Sciences & Biomedicine Critical Care Medicine Emergency Medicine General & Internal Medicine Arterial blood gas analysis Arterial oxygen tension Cerebral performance category Emergency medical services Out-of-hospital cardiac arrest Post-resuscitation care Survival Neurological outcome AMERICAN-HEART-ASSOCIATION INTENSIVE-CARE-UNIT CARBON-DIOXIDE RESUSCITATION HYPEROXIA CARDIOPULMONARY METAANALYSIS MORTALITY BRAIN Arterial blood gas analysis Arterial oxygen tension Cerebral performance category Emergency medical services Neurological outcome Out-of-hospital cardiac arrest Post-resuscitation care Survival Adult Blood Gas Analysis Cardiopulmonary Resuscitation Cohort Studies Humans Out-of-Hospital Cardiac Arrest Oxygen Retrospective Studies Humans Oxygen Blood Gas Analysis Cardiopulmonary Resuscitation Retrospective Studies Cohort Studies Adult Out-of-Hospital Cardiac Arrest Background: Studies to identify safe oxygenation targets after out-of-hospital cardiac arrest (OHCA) have often assumed a linear relationship between arterial oxygen tension (PaO2) and survival, or have dichotomised PaO2 at a supra-physiological level. We hypothesised that abnormalities in mean PaO2 (both high and low) would be associated with decreased survival after OHCA. Methods: We conducted a retrospective multicentre cohort study of adult OHCA patients who received mechanical ventilation on admission to the intensive care unit (ICU). The potential non-linear relationship between the mean PaO2 within the first 24 -hs of ICU admission and survival to hospital discharge (STHD) was assessed by a four-knot restricted cubic spline function with adjustment for potential confounders. Results: 3764 arterial blood gas results were available for 491 patients in the first 24-hs of ICU admission. The relationship between mean PaO2 over the first 24-hs and STHD was an inverted U-shape, with highest survival for those with a mean PaO2 between 100 and 180 mmHg (reference category) compared to a mean PaO2 of <100 mmHg (adjusted odds ratio [aOR] 0.50 95% confidence interval [CI] 0.30, 0.84), or >180 mmHg (aOR 0.41, 95% CI 0.18, 0.92). Mean PaO2 within 24 -hs was the third most important predictor and explained 9.1% of the variability in STHD. Conclusion: The mean PaO2 within the first 24-hs after admission for OHCA has a non-linear association with the highest STHD seen between 100 and 180 mmHg. Randomised controlled trials are now needed to validate the optimal oxygenation targets in mechanically ventilated OHCA patients. 2021 Journal Article http://hdl.handle.net/20.500.11937/93462 10.1016/j.resuscitation.2020.11.021 English http://purl.org/au-research/grants/nhmrc/1029983 http://creativecommons.org/licenses/by-nc-nd/4.0/ ELSEVIER IRELAND LTD fulltext |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Critical Care Medicine Emergency Medicine General & Internal Medicine Arterial blood gas analysis Arterial oxygen tension Cerebral performance category Emergency medical services Out-of-hospital cardiac arrest Post-resuscitation care Survival Neurological outcome AMERICAN-HEART-ASSOCIATION INTENSIVE-CARE-UNIT CARBON-DIOXIDE RESUSCITATION HYPEROXIA CARDIOPULMONARY METAANALYSIS MORTALITY BRAIN Arterial blood gas analysis Arterial oxygen tension Cerebral performance category Emergency medical services Neurological outcome Out-of-hospital cardiac arrest Post-resuscitation care Survival Adult Blood Gas Analysis Cardiopulmonary Resuscitation Cohort Studies Humans Out-of-Hospital Cardiac Arrest Oxygen Retrospective Studies Humans Oxygen Blood Gas Analysis Cardiopulmonary Resuscitation Retrospective Studies Cohort Studies Adult Out-of-Hospital Cardiac Arrest McKenzie, Nicole Finn, Judith Dobb, G. Bailey, P. Arendts, G. Celenza, A. Fatovich, D. Jenkins, I. Ball, Stephen Bray, Janet Ho, K.M. Non-linear association between arterial oxygen tension and survival after out-of-hospital cardiac arrest: A multicentre observational study |
| title | Non-linear association between arterial oxygen tension and survival after out-of-hospital cardiac arrest: A multicentre observational study |
| title_full | Non-linear association between arterial oxygen tension and survival after out-of-hospital cardiac arrest: A multicentre observational study |
| title_fullStr | Non-linear association between arterial oxygen tension and survival after out-of-hospital cardiac arrest: A multicentre observational study |
| title_full_unstemmed | Non-linear association between arterial oxygen tension and survival after out-of-hospital cardiac arrest: A multicentre observational study |
| title_short | Non-linear association between arterial oxygen tension and survival after out-of-hospital cardiac arrest: A multicentre observational study |
| title_sort | non-linear association between arterial oxygen tension and survival after out-of-hospital cardiac arrest: a multicentre observational study |
| topic | Science & Technology Life Sciences & Biomedicine Critical Care Medicine Emergency Medicine General & Internal Medicine Arterial blood gas analysis Arterial oxygen tension Cerebral performance category Emergency medical services Out-of-hospital cardiac arrest Post-resuscitation care Survival Neurological outcome AMERICAN-HEART-ASSOCIATION INTENSIVE-CARE-UNIT CARBON-DIOXIDE RESUSCITATION HYPEROXIA CARDIOPULMONARY METAANALYSIS MORTALITY BRAIN Arterial blood gas analysis Arterial oxygen tension Cerebral performance category Emergency medical services Neurological outcome Out-of-hospital cardiac arrest Post-resuscitation care Survival Adult Blood Gas Analysis Cardiopulmonary Resuscitation Cohort Studies Humans Out-of-Hospital Cardiac Arrest Oxygen Retrospective Studies Humans Oxygen Blood Gas Analysis Cardiopulmonary Resuscitation Retrospective Studies Cohort Studies Adult Out-of-Hospital Cardiac Arrest |
| url | http://hdl.handle.net/20.500.11937/93462 |