• Resuscitation · Dec 2024

    Effects of very early hyperoxemia on neurologic outcome after out-of-hospital cardiac arrest: A secondary analysis of the TTM-2 trial.

    • Filippo Sanfilippo, Agnieszka Uryga, Cristina Santonocito, Janus Christian Jakobsen, Gisela Lilja, Hans Friberg, Pedro David Wendel-Garcia, Paul J Young, Glenn Eastwood, Michelle S Chew, Johan Unden, Matthew Thomas, Anders M Grejs, Matt P Wise, Andreas Lundin, Jacob Hollenberg, Naomi Hammond, Manoj Saxena, Annborn Martin, Robert Bánszky, Fabio Silvio Taccone, Josef Dankiewicz, Niklas Nielsen, Florian Ebner, Jan BeloholaveK, Matthias Hanggi, Luca Montagnani, Nicolo' Patroniti, Chiara Robba, and TTM-2 investigators.
    • Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy; Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
    • Resuscitation. 2024 Dec 7: 110460110460.

    PurposeHyperoxemia is common in patients resuscitated after out-of-hospital cardiac arrest (OHCA) admitted to the intensive care unit (ICU) and may increase the risk of mortality. However, the effect of hyperoxemia on functional outcome, specifically related to the timing of exposure to hyperoxemia, remains unclear.MethodsThe secondary analysis of the Target Temperature Management 2 (TTM-2) randomized trial. The primary aim was to identify the best cut-off of partial arterial pressure of oxygen (PaO2) to predict poor functional outcome within the first 24 h from admission, with this period further separated into 'very early' (0-4 h), 'early' (8-24 h), and 'late' (28-72 h) periods. Hyperoxemia was defined as the highest PaO2 recorded during each period. Poor functional outcome was defined as a 6 months modified Rankin Score (mRS) of 4 to 6.ResultsA total of 1,631 patients were analysed for the 'very early' and 'early' periods, and 1,591 in the 'late period'. In a multivariate logistic regression model, a PaO2 above 245 mmHg during the very early phase was independently associated with a higher probability of poor functional outcome (Odds Ratio, OR = 1.63, 95 % Confidence Interval, CI 1.08-2.44, p = 0.019). No significant associations were found for the later periods.ConclusionsVery early hyperoxemia after ICU admission is associated with higher risk of poor functional outcome after OHCA. Avoiding hyperoxia in the initial hours after resuscitation should be considered.Copyright © 2024. Published by Elsevier B.V.

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