Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest

被引：90

作者：

Eastwood, G. ^{[1
,3
]}

Nichol, A. D. ^{[3
,15
]}

Hodgson, C. ^{[3
,5
,7
,12
]}

Parke, R. L. ^{[16
,18
,20
]}

McGuinness, S. ^{[3
,16
,20
]}

Nielsen, N. ^{[23
,26
]}

Bernard, S. ^{[4
,5
]}

Skrifvars, M. B. ^{[28
]}

Stub, D. ^{[4
,6
]}

Taccone, F. S. ^{[31
]}

Archer, J. ^{[2
,8
]}

Kutsogiannis, D. ^{[22
,33
]}

Dankiewicz, J. ^{[23
,24
]}

Lilja, G. ^{[25
]}

Cronberg, T. ^{[25
]}

Kirkegaard, H. ^{[34
,35
,36
]}

Capellier, G. ^{[3
,40
]}

Landoni, G. ^{[41
,42
]}

Horn, J. ^{[43
]}

Olasveengen, T. ^{[44
]}

Arabi, Y. ^{[46
,47
,48
]}

Chia, Y. W. ^{[17
,49
,50
,51
]}

Markota, A. ^{[52
]}

Haenggi, M. ^{[53
]}

Wise, M. P. ^{[57
]}

Grejs, A. M. ^{[37
,39
]}

Christensen, S. ^{[37
]}

Munk-Andersen, H. ^{[37
]}

Granfeldt, A. ^{[38
]}

Andersen, G. O. ^{[45
]}

Qvigstad, E. ^{[45
]}

Flaa, A. ^{[45
]}

Thomas, M. ^{[58
]}

Sweet, K. ^{[58
]}

Bewley, J. ^{[58
]}

Backlund, M. ^{[29
]}

Tiainen, M. ^{[30
]}

Iten, M. ^{[54
]}

Levis, A. ^{[55
]}

Peck, L. ^{[1
]}

Walsham, J. ^{[13
,14
]}

Deane, A. ^{[9
,10
]}

Ghosh, A. ^{[11
]}

Annoni, F. ^{[32
]}

Chen, Y.

Knight, D.

Lesona, E. ^{[21
]}

Tlayjeh, H. ^{[46
,47
,48
]}

Svensek, F. ^{[52
]}

McGuigan, P. J. ^{[59
,60
]}

机构：

[1] Monash Univ, Dept Intens Care, Melbourne, Vic, Australia

[2] Monash Univ, Dept Neurol, Melbourne, Vic, Australia

[3] Monash Univ, Austin Hosp, Australian & New Zealand Intens Care Res Ctr, Melbourne, Vic, Australia

[4] Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia

[5] Alfred Hosp, Dept Intens Care, Melbourne, Vic, Australia

[6] Alfred Hosp, Dept Cardiol, Melbourne, Vic, Australia

[7] Univ Melbourne, Div Crit Care, Melbourne, Vic, Australia

[8] Univ Melbourne, Dept Med, Melbourne, Vic, Australia

[9] Univ Melbourne, Dept Crit Care, Melbourne, Vic, Australia

[10] Royal Melbourne Hosp, Dept Intens Care, Melbourne, Vic, Australia

[11] Northern Hosp, Dept Intens Care, Melbourne, Vic, Australia

[12] George Inst Global Hlth, Div Crit Care, Sydney, NSW, Australia

[13] Princess Alexandra Hosp, Intens Care Unit, Brisbane, Qld, Australia

[14] Univ Queensland, Sch Med, Brisbane, Qld, Australia

[15] Univ Coll Dublin, St Vincents Hosp, Clin Res Ctr, Dublin, Ireland

[16] Auckland City Hosp, Cardiothorac & Vasc Intens Care Unit, Auckland, New Zealand

[17] Auckland City Hosp, Dept Crit Care Med, Auckland, New Zealand

[18] Univ Auckland, Sch Nursing, Auckland, New Zealand

[19] Intens Care Res, Wellington, New Zealand

[20] Med Res Inst New Zealand, Wellington, New Zealand

[21] Wellington Reg Hosp, Intens Care Unit, Wellington, New Zealand

[22] Christchurch Hosp, Dept Intens Care, Canterbury, New Zealand

[23] Lund Univ, Skane Univ Hosp, Dept Clin Sci, Sect Anesthesiol & Intens Care, Lund, Sweden

[24] Lund Univ, Skane Univ Hosp, Cardiol Sect, Lund, Sweden

[25] Lund Univ, Skane Univ Hosp, Neurol Sect, Lund, Sweden

[26] Helsingborg Hosp, Helsingborg, Sweden

[27] Skane Univ Hosp, Dept Anesthesia & Intens Care Med, Malmo, Sweden

[28] Helsinki Univ Hosp, Dept Emergency Care & Serv, Helsinki, Finland

[29] Helsinki Univ Hosp, Dept Intens Care, Helsinki, Finland

[30] Dept Neurol, Helsinki, Finland

[31] Univ Libre Bruxelles, Hop Univ Bruxelles, Dept Intens Care, Brussels, Belgium

[32] Erasme Univ Hosp, Dept Intens Care, Brussels, Belgium

[33] Univ Alberta, Fac Med & Dent, Dept Crit Care Med, Edmonton, AB, Canada

[34] Aarhus Univ Hosp, Emergency Dept, Aarhus, Denmark

[35] Aarhus Univ Hosp, Dept Clin Med, Aarhus, Denmark

[36] Aarhus Univ, Aarhus, Denmark

[37] Aarhus Univ Hosp, Dept Intens Care Med, Aarhus, Denmark

[38] Aarhus Univ Hosp, Dept Anesthesiol & Intens Care, Aarhus, Denmark

[39] Aarhus Univ, Dept Clin Med, Aarhus, Denmark

[40] Univ Franche Comte, Ctr Hosp Univ, Unite Format & Rech Sante, Reanimat Med, Besancon, France

[41] Univ Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Dept Anesthesia & Intens Care, Milan, Italy

[42] Univ Vita Salute San Raffaele, Sch Med, Milan, Italy

[43] Amsterdam Univ Med Ctr, Dept Intens Care, Amsterdam, Netherlands

[44] Univ Oslo, Inst Clin Med, Dept Anesthesiol & Intens Care Med, Oslo, Norway

[45] Oslo Univ Hosp Ulleval, Dept Cardiol, Oslo, Norway

[46] Minist Natl Guard Hlth Affairs, Dept Intens Care, Riyadh, Saudi Arabia

[47] King Saud Bin Abdulaziz Univ Hosp Hlth Sci, Coll Med, Riyadh, Saudi Arabia

[48] King Abdullah Int Med Res Ctr, Riyadh, Saudi Arabia

[49] Tan Tock Seng Hosp, Dept Cardiol, Singapore, Singapore

[50] Natl Univ Singapore, Yong Loo Lin Sch Med, Sch Med, Singapore, Singapore

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2023年 / 389卷 / 01期

基金：

英国医学研究理事会;

关键词：

CEREBRAL-BLOOD-FLOW; INTENSIVE-CARE-UNIT; CARBON-DIOXIDE; CARDIOPULMONARY-RESUSCITATION; ARTERIAL PCO2; HYPOTHERMIA; RELIABILITY; METABOLISM; REACTIVITY; GUIDELINES;

D O I：

10.1056/NEJMoa2214552

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Guidelines recommend normocapnia for adults with coma who are resuscitated after out-of-hospital cardiac arrest. However, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes. METHODS We randomly assigned adults with coma who had been resuscitated after out-of-hospital cardiac arrest of presumed cardiac or unknown cause and admitted to the intensive care unit (ICU) in a 1:1 ratio to either 24 hours of mild hypercapnia (target partial pressure of arterial carbon dioxide [Paco 2], 50 to 55 mm Hg) or normocapnia (target Paco 2, 35 to 45 mm Hg). The primary outcome was a favorable neurologic outcome, defined as a score of 5 (indicating lower moderate disability) or higher, as assessed with the use of the Glasgow Outcome Scale-Extended (range, 1 [death] to 8, with higher scores indicating better neurologic outcome) at 6 months. Secondary outcomes included death within 6 months. RESULTS A total of 1700 patients from 63 ICUs in 17 countries were recruited, with 847 patients assigned to targeted mild hypercapnia and 853 to targeted normocapnia. A favorable neurologic outcome at 6 months occurred in 332 of 764 patients (43.5%) in the mild hypercapnia group and in 350 of 784 (44.6%) in the normocapnia group (relative risk, 0.98; 95% confidence interval [CI], 0.87 to 1.11; P = 0.76). Death within 6 months after randomization occurred in 393 of 816 patients (48.2%) in the mild hypercapnia group and in 382 of 832 (45.9%) in the normocapnia group (relative risk, 1.05; 95% CI, 0.94 to 1.16). The incidence of adverse events did not differ significantly between groups. CONCLUSIONS In patients with coma who were resuscitated after out-of-hospital cardiac arrest, targeted mild hypercapnia did not lead to better neurologic outcomes at 6 months than targeted normocapnia.

引用

页码：45 / 57

页数：13

共 39 条

[1] A feasibility study of cerebral oximetry monitoring during the post-resuscitation period in comatose patients following cardiac arrest [J].