Association between early arterial blood gas tensions and neurological outcome in adult patients following in-hospital cardiac arrest

Resuscitation ◽  
2015 ◽  
Vol 89 ◽  
pp. 1-7 ◽  
Author(s):  
Chih-Hung Wang ◽  
Chien-Hua Huang ◽  
Wei-Tien Chang ◽  
Min-Shan Tsai ◽  
Tsung-Chien Lu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Adult Patients ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Hospital Cardiac Arrest

Abstract 251: Association Between Early Arterial Blood Gas Levels and Neurological Outcome in Adult Patients Following In-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Chih-Hung Wang ◽  
Chien-Hua Huang ◽  
Wei-Tien Chang ◽  
Min-Shan Tsai ◽  
Ping-Hsun Yu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Adverse Outcomes ◽  
Adult Patients ◽  
Neurologic Outcome ◽  
Successful Resuscitation ◽  
Arterial Blood ◽  
The Mean ◽  
Hospital Cardiac Arrest

Background: The early partial pressures of arterial O2 (PaO2) and CO2 (PaCO2) have been found in animal studies to be correlated with neurological outcome after brain injury. Recent guidelines for the management of cardiac arrest recommend maintaining the arterial oxyhemoglobin saturation at ≥ 94% and PaCO2 at 40-45 mm Hg after successful resuscitation of patients sustaining cardiac arrest. However, there are few clinical studies that have investigated the relationship of early PaO2 and PaCO2 to the neurological outcomes of resuscitated patients or determined the optimal values for PaO2 and PaCO2. Methods and Results: This was a retrospective observational study from a single medical center of adult patients who had in-hospital cardiac arrest and achieved sustained return of spontaneous circulation (ROSC) between 2006 and 2012. Multivariable logistic regression analysis was used to identify factors associated with favorable neurologic outcome at hospital discharge. A general additive model was used to detect nonlinear relationships between independent and dependent variables. The first PaO2 and PaCO2 values measured after first sustained ROSC were used for analysis. Of the 550 study patients, 154 (28%) survived to hospital discharge and 74 (13.5%) achieved favorable neurologic outcome. The mean time from sustained ROSC to the measurement of PaO2 and PaCO2 was 136.8 minutes. The mean PaO2 and PaCO2 were 167.4 mm Hg and 40.3 mm Hg, respectively. PaO2 between 70 and 240 mmHg (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.08-3.64) and PaCO2 levels (OR 0.98, 95% CI 0.95-0.99) were positively and inversely associated with favorable neurological outcome, respectively. Conclusions: The early PaO2 and PaCO2 levels obtained after ROSC were correlated with neurological outcome of patients with in-hospital cardiac arrest. PaO2 levels between 70 and 240 mm Hg were associated with favorable neurological function at hospital discharge, while higher PaCO2 levels might be associated with adverse outcomes.

scholarly journals Dynamic changes in arterial blood gas during cardiopulmonary resuscitation in out-of-hospital cardiac arrest

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seok-In Hong ◽  
June-Sung Kim ◽  
Youn-Jung Kim ◽  
Won Young Kim
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Gas Analysis ◽  
University Hospital ◽  
Arterial Line ◽  
Blood Gas ◽  
Dynamic Changes ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Hospital Cardiac Arrest

AbstractWe aimed to investigate the prognostic value of dynamic changes in arterial blood gas analysis (ABGA) measured after the start of cardiopulmonary resuscitation (CPR) for return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). This prospective observational study was conducted at the emergency department of a university hospital from February 2018 to February 2020. All blood samples for gas analysis were collected from a radial or femoral arterial line, which was inserted during CPR. Changes in ABGA parameters were expressed as delta (Δ), defined as the values of the second ABGA minus the values of the initial ABGA. The primary outcome was sustained ROSC. Out of the 80 patients included in the analysis, 13 achieved sustained ROSC after in-hospital resuscitation. Multivariable logistic analysis revealed that ΔpaO2 (odds ratio [OR] = 1.023; 95% confidence interval [CI] = 1.004–1.043, p = 0.020) along with prehospital shockable rhythm (OR = 84.680; 95% CI = 2.561–2799.939, p = 0.013) and total resuscitation duration (OR = 0.881; 95% CI = 0.805–0.964, p = 0.006) were significant predictors for sustained ROSC. Our study suggests a possible association between ΔpaO2 in ABGA during CPR and an increased rate of sustained ROSC in the late phase of OHCA.

Arterial Blood Gas Tensions After Resuscitation From Out-of-Hospital Cardiac Arrest

2014 ◽  
Vol 42 (6) ◽  
pp. 1463-1470 ◽  
Author(s):  
Jukka Vaahersalo ◽  
Stepani Bendel ◽  
Matti Reinikainen ◽  
Jouni Kurola ◽  
Marjaana Tiainen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Hospital Cardiac Arrest

A pilot assessment of alpha-stat vs pH-stat arterial blood gas analysis after cardiac arrest

2015 ◽  
Vol 30 (1) ◽  
pp. 138-144 ◽  
Author(s):  
Glenn M. Eastwood ◽  
Satoshi Suzuki ◽  
Cristina Lluch ◽  
Antoine G. Schneider ◽  
Rinaldo Bellomo
Keyword(s):  
Cardiac Arrest ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
Ph Stat

scholarly journals Beyond the limits - ECPR in putative fatal circumstances

CJEM ◽  
2018 ◽  
Vol 20 (S2) ◽  
pp. S70-S73
Author(s):  
Ingo Graeff ◽  
Sylvia Schacher ◽  
Stefan Lenkeit ◽  
Catherine N. Widmann ◽  
Jens-Christian Schewe
Keyword(s):  
Cardiac Arrest ◽  
Water Immersion ◽  
Heart Association ◽  
Prognostic Indicators ◽  
European Resuscitation Council ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Hospital Cardiac Arrest

AbstractThe eligibility criteria for applying extracorporeal cardiopulmonary resuscitation (ECPR) in patients with cardiac arrest are currently unclear. For those patients with hypothermic cardiac arrest, the European Resuscitation Council (ERC) Guidelines recommend considering ECPR only for patients with potassium <8 mmol/L and a body temperature below 32°C, whereas the American Heart Association Guidelines (AHA) do not express this in a specific manner.We report the case of an urban unwitnessed out-of-hospital cardiac arrest patient found with her head immersed in water at a temperature of 23°C. The patient presented an unclear history and a dire combination of clinical and laboratory parameters (asystole, arterial blood gas: pH 6.8, potassium 8.3 mmol/L, lactate 16.0 mmol/L). Despite these poor prognostic indicators, ECPR was initiated after 95 minutes of CPR and the patient survived with a good neurological outcome.This case highlights the uncertainty in ECPR eligibility and prognostication, especially in those with hypothermia and water immersion for whom aggressive therapies may be warranted. Further data and improved strategies are required to delineate candidacy for this resource-intensive procedure better.

Abstract 265: Impact of Changes in the Telephone Cardiopulmonary Resuscitation Instruction After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Ken Nagao ◽  
Hiroyuki Hanada ◽  
Yoshio Tahara ◽  
Hiroshi Nonogi ◽  
Naohiro Yonemoto ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Neurological Outcome ◽  
Group Versus ◽  
Adult Patients ◽  
Similar Proportion ◽  
International Consensus ◽  
Favorable Neurological Outcome ◽  
Hospital Cardiac Arrest

Background: The international consensus on cardiopulmonary resuscitation (CPR) and emergency cardiovascular care science with treatment recommendations (CoSTR) 2010 changed the dispatcher-initiated telephone CPR instruction. Major changes of the telephone CPR instruction were simplified algorithm, elimination of “Look, listen, and feel for breathing” chest compressions first (C-A-B), chest compression only CPR if bystander was not trained in CPR, et al. However, few studies have investigated the efficacy of telephone CPR instruction based on the CoSTR 2010. Methods: From the All-Japan Utstein Registry for out-of-hospital cardiac arrest (OHCA) between 2006 and 2015, we enrolled adult (18 years or older) patients with bystander-witnessed OHCA and stratified by the two CoSTR eras (the CoSTR 2010 group from 2011 through 2015 versus the CoSTR 2005 group from 2006 through 2010). The primary endpoint was 30-day favorable neurological outcome after OHCA. Results: Of the 378,757 adult patients with bystander-witnessed OHCA, 199,117 (52.5%) received CPR based on the CoSTR 2010 and 179,640 (47.4%) received CPR based on the CoSTR 2005. In the whole cohort, the CoSTR 2010 group had higher proportion of cases receiving telephone CPR instruction than the CoSTR 2005 group (48.8% versus 40.9%, P<0.001). In the subgroups of patients receiving telephone CPR instruction, the CoSTR 2010 group had higher proportion of bystander chest compression-only CPR (60.5% versus 47.3%, p<0.001) and public access defibrillation (1.9% versus 0.9%, P<0.001) than the CoSTR 2005 group. Although those subgroups had similar proportion of initial shockable cardiac arrest rhythm (15.2 % in the CoSTR 2010 group versus 15.3 % in the CoSTR 2005 group, P=0.63), the CoSTR 2010 group had higher frequency of the favorable neurological outcome than the CoSTR 2005 group (4.5 % versus 3.7%%, P<0.001). In the subgroup of patients receiving telephone CPR instruction, an adjusted odds ratio for the favorable neurological outcome in the CoSTR 2010 group (reference, the CoSTR 2005 group) was 1.47 (95 % CI, 1.43-1.51, p<0.001). Conclusions: Telephone CPR instruction based on the CoSTR 2010 was the preferable approach to resuscitation for adult patients with bystander-witnessed OHCA.

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