• Janet Bray, Markus B Skrifvars, and Stephen Bernard.
• School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Curtin School of Nursing, Curtin University, Perth, Australia. Electronic address: Janet.bray@monash.edu.
• Resuscitation. 2023 Aug 1; 189: 109899109899.

AbstractA significant focus of post-resuscitation research over the last decade has included optimising oxygenation. This has primarily occurred due to an improved understanding of the possible harmful biological effects of high oxygenation, particularly the neurotoxicity of oxygen free radicals. Animal studies and some observational research in humans suggest harm with the occurrence of severe hyperoxaemia (PaO2 > 300 mmHg) in the post-resuscitation phase. This early data informed in a change in treatment recommendations, with the International Liaison Committee on Resuscitation (ILCOR) recommending the avoidance of hyperoxaemia. However, the optimal oxygenation level for maximal survival has not yet been determined. Recent Phase 3 randomised control trials (RCTs) provide further insight into when oxygen titration should occur. The EXACT RCT suggested that decreasing oxygen fraction post-resuscitation in the prehospital setting, with limited ability to titrate and measure oxygenation, is too soon. The BOX RCT, suggests delaying titration to a normal level in intensive care may be too late. While further RCTs are currently underway in ICU cohorts, titration of oxygen early after arrival at hospital should be considered.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

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