Hyperoxemia is Associated With Poor Neurological Outcomes in Patients With Out-of-Hospital Cardiac Arrest Rescued by Extracorporeal Cardiopulmonary Resuscitation: Insight From the Nationwide Multicenter Observational JAAM-OHCA (Japan Association for Acute Medicine) Registry

被引：6

作者：

Nishihara, Masaaki ^{[1
,2
]}

Hiasa, Ken-ichi ^{[1
]}

Enzan, Nobuyuki ^{[1
]}

Ichimura, Kenzo ^{[3
]}

Iyonaga, Takeshi ^{[1
,2
]}

Shono, Yuji ^{[2
]}

Kashiura, Masahiro ^{[4
]}

Moriya, Takashi ^{[4
]}

Kitazono, Takanari ^{[2
]}

Tsutsui, Hiroyuki ^{[1
]}

机构：

[1] Kyushu Univ, Fac Med Sci, Dept Cardiovasc Med, Fukuoka, Japan

[2] Kyushu Univ Hosp, Emergency & Crit Care Ctr, Fukuoka, Japan

[3] Stanford Univ, Sch Med Pulm Allergy & Crit Care Med, Stanford, CA 94305 USA

[4] Jichi Med Univ, Saitama Med Ctr, Dept Emergency & Crit Care Med, Saitama, Japan

来源：

JOURNAL OF EMERGENCY MEDICINE | 2022年 / 63卷 / 02期

关键词：

out-of-hospital cardiac arrest; extracorporeal cardiopulmonary resuscitation; hyperoxemia; neurological outcome; LIFE-SUPPORT; THERAPEUTIC HYPOTHERMIA; ADULTS; METAANALYSIS; REPERFUSION; DYSFUNCTION; MORTALITY;

D O I：

10.1016/j.jemermed.2022.05.018

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: Previous studies have shown an association between hyperoxemia and mortality in patients with out-of-hospital cardiac arrest (OHCA) after cardiopulmonary resuscitation (CPR); however, evidence is lacking in the extracorporeal CPR (ECPR) setting. Objective: The aim of this study was to test the hypothesis that hyperoxemia is associated with poor neurological outcomes in patients treated by ECPR. Methods: The Japanese Association for Acute Medicine OHCA Registry is a multicenter, prospective, observational registry of patients from 2014 to 2017. Adult (18 years or older) patients who had undergone ECPR after OHCA were included. Eligible patients were divided into two groups based on the partial pressure of oxygen in arterial blood (PaO2) levels at 24 h after ECPR: the high-PaO2 group (n = 242) defined as PaO2 >= 157 mm Hg (median) and the low-PaO2 group (n = 211) defined as PaO2 60 to < 157 mm Hg. The primary outcome was the favorable neurological outcome, defined as a Cerebral Performance Categories Scale score of 1 to 2 at 30 days after OHCA. Results: Of 34,754 patients with OHCA, 453 patients were included. The neurological outcome was significantly lower in the high-PaO2 group than in the low-PaO2 group (15.9 vs. 33.5%; p < 0.001). After adjusting for potential confounders, high PaO2 was negatively associated with favorable neurological outcomes (adjusted odds ratio [aOR] 0.48; 95% confidence interval [CI] 0.24-0.97; p = 0.040). In a multivariate analysis with multiple imputation, high PaO2 was also negatively associated with favorable neurological outcomes (aOR 0.63; 95% CI 0.49-0.81; p < 0.001). Conclusions: Hyperoxemia was associated with worse neurological outcomes in OHCA patients with ECPR. (c) 2022 Elsevier Inc. All rights reserved.

引用

页码：221 / 230

页数：10

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