• Paul J Young, Michael Bailey, Rinaldo Bellomo, Stephen Bernard, Janet Bray, Pekka Jakkula, Markku Kuisma, Diane Mackle, Daniel Martin, Jerry P Nolan, Rakshit Panwar, Matti Reinikainen, Markus B Skrifvars, and Matt Thomas.
• Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand. Electronic address: paul.young@ccdhb.org.nz.
• Resuscitation. 2020 Dec 1; 157: 15-22.

AimThe effect of conservative versus liberal oxygen therapy on mortality rates in post cardiac arrest patients is uncertain.MethodsWe 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.ResultsIndividual 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 follow-up; 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.ConclusionConservative 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 NumberCRD42019138931.Copyright © 2020 Elsevier B.V. All rights reserved.

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