Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: an exploratory Target Temperature Management Trial substudy
Abstract Background Dyscarbia is common in out-of-hospital cardiac arrest (OHCA) patients and its association to neurological outcome is undetermined. Methods This is an exploratory post-hoc substudy of the Target Temperature Management (TTM) trial, including resuscitated OHCA patients, investigatin...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-08-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13054-018-2119-5 |
| _version_ | 1819080159882379264 |
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| author | Florian Ebner Matt B. A. Harmon Anders Aneman Tobias Cronberg Hans Friberg Christian Hassager Nicole Juffermans Jesper Kjærgaard Michael Kuiper Niklas Mattsson Paolo Pelosi Susann Ullén Johan Undén Matt P. Wise Niklas Nielsen |
| author_facet | Florian Ebner Matt B. A. Harmon Anders Aneman Tobias Cronberg Hans Friberg Christian Hassager Nicole Juffermans Jesper Kjærgaard Michael Kuiper Niklas Mattsson Paolo Pelosi Susann Ullén Johan Undén Matt P. Wise Niklas Nielsen |
| author_sort | Florian Ebner |
| collection | DOAJ |
| description | Abstract Background Dyscarbia is common in out-of-hospital cardiac arrest (OHCA) patients and its association to neurological outcome is undetermined. Methods This is an exploratory post-hoc substudy of the Target Temperature Management (TTM) trial, including resuscitated OHCA patients, investigating the association between serial measurements of arterial partial carbon dioxide pressure (PaCO2) and neurological outcome at 6 months, defined by the Cerebral Performance Category (CPC) scale, dichotomized to good outcome (CPC 1 and 2) and poor outcome (CPC 3–5). The effects of hypercapnia and hypocapnia, and the time-weighted mean PaCO2 and absolute PaCO2 difference were analyzed. Additionally, the association between mild hypercapnia (6.0–7.30 kPa) and neurological outcome, its interaction with target temperature (33 °C and 36 °C), and the association between PaCO2 and peak serum-Tau were evaluated. Results Of the 939 patients in the TTM trial, 869 were eligible for analysis. Ninety-six percent of patients were exposed to hypocapnia or hypercapnia. None of the analyses indicated a statistical significant association between PaCO2 and neurological outcome (P = 0.13–0.96). Mild hypercapnia was not associated with neurological outcome (P = 0.78) and there was no statistically significant interaction with target temperature (P interaction = 0.95). There was no association between PaCO2 and peak serum-Tau levels 48 or 72 h after return of spontaneous circulation (ROSC). Conclusions Dyscarbia is common after ROSC. No statistically significant association between PaCO2 in the post-cardiac arrest phase and neurological outcome at 6 months after cardiac arrest was detected. There was no significant interaction between mild hypercapnia and temperature in relation to neurological outcome. |
| first_indexed | 2024-12-21T19:40:27Z |
| format | Article |
| id | doaj.art-ff98845809b041b28c1ae7a2e475d5f9 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-21T19:40:27Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-ff98845809b041b28c1ae7a2e475d5f92022-12-21T18:52:29ZengBMCCritical Care1364-85352018-08-0122111010.1186/s13054-018-2119-5Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: an exploratory Target Temperature Management Trial substudyFlorian Ebner0Matt B. A. Harmon1Anders Aneman2Tobias Cronberg3Hans Friberg4Christian Hassager5Nicole Juffermans6Jesper Kjærgaard7Michael Kuiper8Niklas Mattsson9Paolo Pelosi10Susann Ullén11Johan Undén12Matt P. Wise13Niklas Nielsen14Department of Anesthesia and Intensive Care, Helsingborg HospitalDepartment of Intensive Care Medicine, Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of AmsterdamDepartment of Intensive Care, Liverpool HospitalDepartment of Clinical Sciences, Neurology, Skåne University HospitalDepartment of Anaesthesia and Intensive Care, Skåne University HospitalDepartment of Cardiology, Rigshospitalet, University of CopenhagenDepartment of Intensive Care Medicine, Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of AmsterdamDepartment of Cardiology, Rigshospitalet, University of CopenhagenIntensive Care Unit, Leeuwarden Medical CentrumDepartment of Clinical Sciences, Neurology, Skåne University HospitalDepartment of Surgical Sciences and Integrated Diagnostics, Anesthesia and Intensive Care, San Martino Policlinico Hospital, University of GenoaClinical Studies Sweden, Skåne University HospitalDepartment of Anaesthesia and Intensive Care, Hallands HospitalAdult Critical Care, University Hospital of WalesDepartment of Anesthesia and Intensive Care, Helsingborg HospitalAbstract Background Dyscarbia is common in out-of-hospital cardiac arrest (OHCA) patients and its association to neurological outcome is undetermined. Methods This is an exploratory post-hoc substudy of the Target Temperature Management (TTM) trial, including resuscitated OHCA patients, investigating the association between serial measurements of arterial partial carbon dioxide pressure (PaCO2) and neurological outcome at 6 months, defined by the Cerebral Performance Category (CPC) scale, dichotomized to good outcome (CPC 1 and 2) and poor outcome (CPC 3–5). The effects of hypercapnia and hypocapnia, and the time-weighted mean PaCO2 and absolute PaCO2 difference were analyzed. Additionally, the association between mild hypercapnia (6.0–7.30 kPa) and neurological outcome, its interaction with target temperature (33 °C and 36 °C), and the association between PaCO2 and peak serum-Tau were evaluated. Results Of the 939 patients in the TTM trial, 869 were eligible for analysis. Ninety-six percent of patients were exposed to hypocapnia or hypercapnia. None of the analyses indicated a statistical significant association between PaCO2 and neurological outcome (P = 0.13–0.96). Mild hypercapnia was not associated with neurological outcome (P = 0.78) and there was no statistically significant interaction with target temperature (P interaction = 0.95). There was no association between PaCO2 and peak serum-Tau levels 48 or 72 h after return of spontaneous circulation (ROSC). Conclusions Dyscarbia is common after ROSC. No statistically significant association between PaCO2 in the post-cardiac arrest phase and neurological outcome at 6 months after cardiac arrest was detected. There was no significant interaction between mild hypercapnia and temperature in relation to neurological outcome.http://link.springer.com/article/10.1186/s13054-018-2119-5Out-of-hospital cardiac arrestCarbon dioxide partial pressureCerebral performanceBiomarkerSerum Tau |
| spellingShingle | Florian Ebner Matt B. A. Harmon Anders Aneman Tobias Cronberg Hans Friberg Christian Hassager Nicole Juffermans Jesper Kjærgaard Michael Kuiper Niklas Mattsson Paolo Pelosi Susann Ullén Johan Undén Matt P. Wise Niklas Nielsen Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: an exploratory Target Temperature Management Trial substudy Critical Care Out-of-hospital cardiac arrest Carbon dioxide partial pressure Cerebral performance Biomarker Serum Tau |
| title | Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: an exploratory Target Temperature Management Trial substudy |
| title_full | Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: an exploratory Target Temperature Management Trial substudy |
| title_fullStr | Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: an exploratory Target Temperature Management Trial substudy |
| title_full_unstemmed | Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: an exploratory Target Temperature Management Trial substudy |
| title_short | Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: an exploratory Target Temperature Management Trial substudy |
| title_sort | carbon dioxide dynamics in relation to neurological outcome in resuscitated out of hospital cardiac arrest patients an exploratory target temperature management trial substudy |
| topic | Out-of-hospital cardiac arrest Carbon dioxide partial pressure Cerebral performance Biomarker Serum Tau |
| url | http://link.springer.com/article/10.1186/s13054-018-2119-5 |
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