Early oxygenation and ventilation measurements after pediatric cardiac arrest: lack of association with outcome. (Dugan)

Crit Care Med. 2013 Jun;41(6):1534-1542. PMID: 23552509

OBJECTIVES: To explore oxygenation and ventilation status early after cardiac arrest in infants and children. We hypothesize that hyperoxia is common and associated with worse outcome after pediatric cardiac arrest.

DESIGN: Retrospective cohort study.

SETTING: Fifteen hospitals within the Pediatric Emergency Care Applied Research Network.

PATIENTS: Children who suffered a cardiac arrest event and survived for at least 6 hoursafter return of circulation.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Analysis of 195 events revealed that abnormalities in oxygenation andventilation are common during the initial 6 hours after pediatric cardiac arrest. Hyperoxia was frequent, affecting 54% of patients. Normoxia was documented in 34% and hypoxia in 22% of patients. These percentages account for a 10% overlap of patients who had both hyperoxia and hypoxia. Ventilation status was more evenly distributed with hyperventilation observed in 38%, normoventilation in 29%, and hypoventilation in 46%, with a 13% overlap of patients who had both hyperventilation and hypoventilation. Derangements in bothoxygenation and ventilation were common early after cardiac arrest such that both normoxia and normocarbia were documented in only 25 patients (13%). Neitheroxygenation nor ventilation status was associated with outcome. After controlling for potential confounders, arrest location and rhythm were significantly associated with worse outcome; however, hyperoxia was not (odds ratio for good outcome, 1.02 [0.46, 2.84]; p = 0.96).

CONCLUSIONS: Despite recent resuscitation guidelines that advocate maintenance of normoxia and normoventilation after pediatric cardiac arrest, this is uncommonly achieved in practice. Although we did not demonstrate an associationbetween hyperoxia and worse outcome, the small proportion of patients kept within normal ranges limited our power. Preclinical data suggesting potential harm with hyperoxia remain compelling, and further investigation, including prospective, large studies involving robust recording of physiological derangements, is necessary to further advance our understanding of this important topic.

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