Conservative or liberal oxygen therapy in adults after cardiac arrest An individual-level patient data meta-analysis of randomised controlled trials

被引:48
作者
Young, Paul J. [1 ,2 ]
Bailey, Michael [3 ,4 ]
Bellomo, Rinaldo [3 ,4 ,5 ,6 ]
Bernard, Stephen [7 ]
Bray, Janet [7 ]
Jakkula, Pekka [8 ,9 ]
Kuisma, Markku [10 ]
Mackle, Diane [1 ]
Martin, Daniel [11 ,12 ]
Nolan, Jerry P. [13 ,14 ]
Panwar, Rakshit [15 ,16 ]
Reinikainen, Matti [17 ,18 ]
Skrifvars, Markus B. [9 ,19 ]
Thomas, Matt [20 ]
机构
[1] Med Res Inst New Zealand, Wellington, New Zealand
[2] Wellington Hosp, Intens Care Unit, Wellington, New Zealand
[3] Monash Univ, Australian & New Zealand Intens Care Res Ctr, Melbourne, Vic, Australia
[4] Univ Melbourne, Parkville, Vic, Australia
[5] Austin Hosp, Intens Care Unit, Heidelberg, Vic, Australia
[6] Univ Melbourne, Ctr Integrated Crit Care, Parkville, Vic, Australia
[7] Monash Univ, Dept Epidemiol & Prevent Med, Clayton, Vic, Australia
[8] Univ Helsinki, Dept Perioperat Intens Care & Pain Med, Helsinki, Finland
[9] Helsinki Univ Hosp, Helsinki, Finland
[10] Helsinki Univ Hosp, Dept Emergency Med, Helsinki, Finland
[11] Royal Free Hosp, Intens Care Unit, London, England
[12] Univ Plymouth, Peninsula Med Sch, Plymouth, Devon, England
[13] Univ Warwick, Warwick Clin Trials Unit, Coventry, W Midlands, England
[14] Royal United Hosp, Anaesthesia & Intens Care Med, Bath, Avon, England
[15] John Hunter Hosp, Intens Care Unit, New Lambton Hts, NSW, Australia
[16] Univ Newcastle, Sch Med & Publ Hlth, Newcastle, NSW, Australia
[17] Univ Eastern Finland, Inst Clin Med, Kuopio, Finland
[18] Kuopio Univ Hosp, Dept Anaesthesiol & Intens Care, Kuopio, Finland
[19] Univ Helsinki, Dept Emergency Care & Serv, Helsinki, Finland
[20] Univ Hosp Bristol & Weston NHS Fdn Trust, Intens Care Unit, Bristol, Avon, England
关键词
Oxygen therapy; Cardiac arrest; Hypoxic ischaemic encephalopathy; Hyperoxaemia; Hypoxaemia; Randomised controlled trial; Individual patient data meta-analysis; RESUSCITATION; ASSOCIATION; CONSENSUS; CARE;
D O I
10.1016/j.resuscitation.2020.09.036
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Aim: The effect of conservative versus liberal oxygen therapy on mortality rates in post cardiac arrest patients is uncertain. Methods: We undertook an individual patient data meta-analysis of patients randomised in clinical trials to conservative or liberal oxygen therapy after a cardiac arrest. The primary end point was mortality at last follow-up. Results: Individual level patient data were obtained from seven randomised clinical trials with a total of 429 trial participants included. Four trials enrolled patients in the pre-hospital period. Of these, two provided protocol-directed oxygen therapy for 60 min, one provided it until the patient was handed over to the emergency department staff, and one provided it for a total of 72 h or until the patient was extubated. Three trials enrolled patients after intensive care unit (ICU) admission and generally continued protocolised oxygen therapy for a longer period, often until ICU discharge. A total of 90 of 221 patients (40.7%) assigned to conservative oxygen therapy and 103 of 206 patients (50%) assigned to liberal oxygen therapy had died by this last point of followup; absolute difference; odds ratio (OR) adjusted for study only; 0.67; 95% CI 0.45 to 0.99; P = 0.045; adjusted OR, 0.58; 95% CI 0.35 to 0.96; P = 0.04. Conclusion: Conservative oxygen therapy was associated with a statistically significant reduction in mortality at last follow-up compared to liberal oxygen therapy but the certainty of available evidence was low or very low due to bias, imprecision, and indirectness. PROSPERO registration number: CRD42019138931.
引用
收藏
页码:15 / 22
页数:8
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