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- Xianming Qiu, Yuke Zhang, Quanzhen Wang, Zhiming Jiang, Li Kong, and Lei Zhou.
- Department of Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China; Shandong Institute of Respiratory Diseases, Jinan, China; Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China.
- Am J Emerg Med. 2024 Dec 10; 89: 5115-11.
BackgroundBrain injury often occurs after cardiac arrest, and the regulation of PaCO2 plays a crucial role in mediating cerebral blood flow. The current guidelines recommend maintaining normocapnia through ventilation in post-arrest patients. However, the effects of hypercapnia on neurological outcomes remain controversial. To address this issue, we undertook a meta-analysis to compare the effects of hypercapnia and normocapnia on the neurological outcomes in patients with cardiac arrest.MethodsAs of December 5, 2023, we conducted a search on eligible studies, including EMBASE, PubMed, and WOS databases. Our primary outcome of interest was a good neurological outcome, and two authors independently screened the studies and extracted relevant data. For analysis, a fixed effects model was used when the I2 values were less than 50 %, whereas a random effects model was used for higher I2 values.ResultsFrom the 2137 studies initially identified, seven studies involving 2770 patients were ultimately included. Compared with normocapnia, hypercapnia significantly improved the neurological outcomes of patients with cardiac arrest (OR 0.73; 95 % CI 0.56-0.96; P = 0.02). According to the subgroup analysis, the hypercapnic group achieved better neurological outcomes in the short-term than did the normocapnia group (OR 0.61; 95 % CI 0.42-0.88; P = 0.008), whereas no significant difference was observed in long-term (OR 0.91; 95 % CI 0.76-1.10; P = 0.35). Moreover, there was no significant difference in mortality between the two groups (OR 1.03; 95 % CI 0.65-1.63; P = 0.91).ConclusionOur results suggest that hypercapnia is associated with a good neurological prognosis, especially in the short-term setting. However, further well-powered randomized controlled trials are necessary to confirm the optimal PaCO2 targets.ProsperoCRD42023457027. Registered 3 September 2023.Copyright © 2024 Elsevier Inc. All rights reserved.
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