Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study
Purpose: International guidelines recommend targeting normocapnia in mechanically ventilated out-of-hospital cardiac arrest (OHCA) survivors, but the optimal arterial carbon dioxide (PaCO2) target remains controversial. We hypothesised that the relationship between PaCO2 and survival is non-linear,...
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| Format: | Journal Article |
| Language: | English |
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ELSEVIER IRELAND LTD
2021
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| Online Access: | http://purl.org/au-research/grants/nhmrc/1029983 http://hdl.handle.net/20.500.11937/93463 |
| _version_ | 1848765736033452032 |
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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 | Purpose: International guidelines recommend targeting normocapnia in mechanically ventilated out-of-hospital cardiac arrest (OHCA) survivors, but the optimal arterial carbon dioxide (PaCO2) target remains controversial. We hypothesised that the relationship between PaCO2 and survival is non-linear, and targeting an intermediate level of PaCO2 compared to a low or high PaCO2 in the first 24-h of ICU admission is associated with an improved survival to hospital discharge (STHD) and at 12-months. Methods: We conducted a retrospective multi-centre cohort study of adults with non-traumatic OHCA requiring admission to one of four tertiary hospital intensive care units for mechanical ventilation. A four-knot restricted cubic spline function was used to allow non-linearity between the mean PaCO2 within the first 24 h of ICU admission after OHCA and survival, and optimal PaCO2 cut-points were identified from the spline curve to generate corresponding odds ratios. Results: We analysed 3769 PaCO2 results within the first 24-h of ICU admission, from 493 patients. PaCO2 and survival had an inverted U-shape association; normocapnia was associated with significantly improved STHD compared to either hypocapnia (<35 mmHg) (adjusted odds ratio [aOR] 0.45, 95% confidence interval [CI] 0.24−0.83) or hypercapnia (>45 mmHg) (aOR 0.45, 95% CI 0.24−0.84). Of the twelve predictors assessed, PaCO2 was the third most important predictor, and explained >11% of the variability in survival. The survival benefits of normocapnia extended to 12-months. Conclusions: Normocapnia within the first 24-h of intensive care admission after OHCA was associated with an improved survival compared to patients with hypocapnia or hypercapnia. |
| first_indexed | 2025-11-14T11:39:59Z |
| format | Journal Article |
| id | curtin-20.500.11937-93463 |
| 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-20.500.11937-934632023-10-25T07:44:04Z Arterial carbon dioxide tension has a non-linear association with 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 carbon dioxide tension Out-of-hospital cardiac arrest Post-resuscitation care Survival Neurological outcome INTENSIVE-CARE-UNIT BLOOD GAS TENSIONS BRAIN-INJURY RESUSCITATION GUIDELINES MORTALITY OXYGEN TRIAL Arterial carbon dioxide tension Neurological outcome Out-of-hospital cardiac arrest Post-resuscitation care Survival Adult Carbon Dioxide Cohort Studies Humans Hypercapnia Out-of-Hospital Cardiac Arrest Retrospective Studies Humans Hypercapnia Carbon Dioxide Retrospective Studies Cohort Studies Adult Out-of-Hospital Cardiac Arrest Purpose: International guidelines recommend targeting normocapnia in mechanically ventilated out-of-hospital cardiac arrest (OHCA) survivors, but the optimal arterial carbon dioxide (PaCO2) target remains controversial. We hypothesised that the relationship between PaCO2 and survival is non-linear, and targeting an intermediate level of PaCO2 compared to a low or high PaCO2 in the first 24-h of ICU admission is associated with an improved survival to hospital discharge (STHD) and at 12-months. Methods: We conducted a retrospective multi-centre cohort study of adults with non-traumatic OHCA requiring admission to one of four tertiary hospital intensive care units for mechanical ventilation. A four-knot restricted cubic spline function was used to allow non-linearity between the mean PaCO2 within the first 24 h of ICU admission after OHCA and survival, and optimal PaCO2 cut-points were identified from the spline curve to generate corresponding odds ratios. Results: We analysed 3769 PaCO2 results within the first 24-h of ICU admission, from 493 patients. PaCO2 and survival had an inverted U-shape association; normocapnia was associated with significantly improved STHD compared to either hypocapnia (<35 mmHg) (adjusted odds ratio [aOR] 0.45, 95% confidence interval [CI] 0.24−0.83) or hypercapnia (>45 mmHg) (aOR 0.45, 95% CI 0.24−0.84). Of the twelve predictors assessed, PaCO2 was the third most important predictor, and explained >11% of the variability in survival. The survival benefits of normocapnia extended to 12-months. Conclusions: Normocapnia within the first 24-h of intensive care admission after OHCA was associated with an improved survival compared to patients with hypocapnia or hypercapnia. 2021 Journal Article http://hdl.handle.net/20.500.11937/93463 10.1016/j.resuscitation.2021.01.035 English http://purl.org/au-research/grants/nhmrc/1029983 http://purl.org/au-research/grants/nhmrc/1174838 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 carbon dioxide tension Out-of-hospital cardiac arrest Post-resuscitation care Survival Neurological outcome INTENSIVE-CARE-UNIT BLOOD GAS TENSIONS BRAIN-INJURY RESUSCITATION GUIDELINES MORTALITY OXYGEN TRIAL Arterial carbon dioxide tension Neurological outcome Out-of-hospital cardiac arrest Post-resuscitation care Survival Adult Carbon Dioxide Cohort Studies Humans Hypercapnia Out-of-Hospital Cardiac Arrest Retrospective Studies Humans Hypercapnia Carbon Dioxide 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. Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study |
| title | Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study |
| title_full | Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study |
| title_fullStr | Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study |
| title_full_unstemmed | Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study |
| title_short | Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: A multicentre observational study |
| title_sort | arterial carbon dioxide tension has a non-linear association with 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 carbon dioxide tension Out-of-hospital cardiac arrest Post-resuscitation care Survival Neurological outcome INTENSIVE-CARE-UNIT BLOOD GAS TENSIONS BRAIN-INJURY RESUSCITATION GUIDELINES MORTALITY OXYGEN TRIAL Arterial carbon dioxide tension Neurological outcome Out-of-hospital cardiac arrest Post-resuscitation care Survival Adult Carbon Dioxide Cohort Studies Humans Hypercapnia Out-of-Hospital Cardiac Arrest Retrospective Studies Humans Hypercapnia Carbon Dioxide Retrospective Studies Cohort Studies Adult Out-of-Hospital Cardiac Arrest |
| url | http://purl.org/au-research/grants/nhmrc/1029983 http://purl.org/au-research/grants/nhmrc/1029983 http://hdl.handle.net/20.500.11937/93463 |