Post-Resuscitation Partial Pressure of Arterial Carbon Dioxide and Outcome in Patients with Out-of-Hospital Cardiac Arrest: A Multicenter Retrospective Cohort Study

We aimed to estimate the association between PaCO2 level in the patient after out-of-hospital cardiac arrest (OHCA) resuscitation with patient outcome based on a multicenter prospective cohort registry in Japan between June 2014 and December 2015. Based on the PaCO2 within 24 h after return of spontaneous circulation (ROSC), patients were divided into six groups as follows: severe hypocapnia (<25 mmHg), mild hypocapnia (25-35 mmHg,), normocapnia (35-45 mmHg), mild hypercapnia (45-55 mmHg), severe hypercapnia (>55 mmHg), or exposure to both hypocapnia and hypercapnia. Multivariate logistic regression analysis was conducted to calculate the adjusted odds ratios (aORs) and 95% confidence interval (CI) for the 1-month poor neurological outcome (Cerebral Performance Category >= 3). Among the 13,491 OHCA patients, 607 were included. Severe hypocapnia, mild hypocapnia, severe hypercapnia, and exposure to both hypocapnia and hypercapnia were associated with a higher rate of 1-month poor neurological outcome compared with mild hypercapnia (aORs 6.68 [95% CI 2.16-20.67], 2.56 [1.30-5.04], 2.62 [1.06-6.47], and 5.63 [2.21-14.34], respectively). There was no significant difference between the outcome of patients with normocapnia and mild hypercapnia. In conclusion, maintaining normocapnia and mild hypercapnia during the 24 h after ROSC was associated with better neurological outcomes than other PaCO2 abnormalities in this study.