Arginine and Arginine/ADMA Ratio Predict 90-Day Mortality in Patients with Out-of-Hospital Cardiac Arrest—Results from the Prospective, Observational COMMUNICATE Trial

(1) Background: In patients with shock, the L-arginine nitric oxide pathway is activated, causing an elevation of nitric oxide, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) levels. Whether these metabolites provide prognostic information in patients after out-of-hospital cardiac arrest (OHCA) remains unclear. (2) Methods: We prospectively included OHCA patients, recorded clinical parameters and measured plasma ADMA, SDMA and Arginine levels by liquid chromatography tandem mass spectrometry (LC-MS). The primary endpoint was 90-day mortality. (3) Results: Of 263 patients, 130 (49.4%) died within 90 days after OHCA. Compared to survivors, non-survivors had significantly higher levels of ADMA and lower Arginine and Arginine/ADMA ratios in univariable regression analyses. Arginine levels and Arginine/ADMA ratio were significantly associated with 90-day mortality (OR 0.51 (95%CI 0.34 to 0.76), p < 0.01 and OR 0.40 (95%CI 0.26 to 0.61), p < 0.001, respectively). These associations remained significant in several multivariable models. Arginine/ADMA ratio had the highest predictive value with an area under the curve (AUC) of 0.67 for 90-day mortality. Results for secondary outcomes were similar with significant associations with in-hospital mortality and neurological outcome. (4) Conclusion: Arginine and Arginine/ADMA ratio were independently associated with 90-day mortality and other adverse outcomes in patients after OHCA. Whether therapeutic modification of the L-arginine-nitric oxide pathway has the potential to improve outcome should be evaluated.

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An Early Predictive Scoring Model for In-Hospital Cardiac Arrest of Emergent Hemodialysis Patients

Journal of Clinical Medicine ◽

10.3390/jcm10153241 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3241

Author(s):

Shih-Hao Chen ◽

Ya-Yun Cheng ◽

Chih-Hao Lin

Keyword(s):

Cardiac Arrest ◽

Risk Group ◽

Vital Signs ◽

Area Under The Curve ◽

Hemodialysis Patients ◽

High Risk Group ◽

Predictive Score ◽

Primary Group ◽

Sum Scores ◽

Hospital Cardiac Arrest

Background: Patients undergoing hemodialysis are prone to cardiac arrests. Methods: This study aimed to develop a risk score to predict in-hospital cardiac arrest (IHCA) in emergency department (ED) patients undergoing emergency hemodialysis. Patients were included if they received urgent hemodialysis within 24 h after ED arrival. The primary outcome was IHCA within three days. Predictors included three domains: comorbidity, triage information (vital signs), and initial biochemical results. The final model was generated from data collected between 2015 and 2018 and validated using data from 2019. Results: A total of 257 patients, including 52 with IHCA, were analyzed. Statistical analysis selected significant variables with higher sensitivity cutoff, and scores were assigned based on relative beta coefficient ratio: K > 5.5 mmol/L (score 1), pH < 7.35 (score 1), oxygen saturation < 85% (score 1), and mean arterial pressure < 80 mmHg (score 2). The final scoring system had an area under the curve of 0.78 (p < 0.001) in the primary group and 0.75 (p = 0.023) in the validation group. The high-risk group (defined as sum scores ≥ 3) had an IHCA risk of 47.2% and 41.7%, while the low-risk group (sum scores < 3) had 18.3% and 7%, in the primary and validation databases, respectively. Conclusions: This predictive score model for IHCA in emergent hemodialysis patients could help healthcare providers to take necessary precautions and allocate resources.

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Abstract 135: N-Terminal Pro-B-Type Natriuretic Peptide May Serve as a Prognostic Indicator for 30-Day Mortality Following Out-Of-Hospital Cardiac Arrest, Whereas Both High-Sensitivity Cardiac Troponin-T and Copeptin Did Not Yield Prognostic Information

Circulation ◽

10.1161/circ.140.suppl_2.135 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Reidun Aarsetoey ◽

Torbjorn Omland ◽

Helge Rosjo ◽

Heidi Strand ◽

Hildegunn Aarsetoey ◽

...

Keyword(s):

Cardiac Arrest ◽

Troponin T ◽

Univariate Analysis ◽

Heart Rhythm ◽

Cox Proportional Hazards Model ◽

Prognostic Indicators ◽

Prognostic Information ◽

Coronary Syndrome ◽

Significant Difference ◽

Hospital Cardiac Arrest

Introduction: Sudden cardiac arrest (SCA) may be due to different underlying conditions. Prior heart disease is a major risk factor, and coronary artery disease is the most common underlying cause. Hs-cTnT and copeptin are used for early diagnosis of acute myocardial infarction, and may also serve as prognostic indicators following an acute coronary syndrome. NT-proBNP is a marker of heart failure and may act as a predictor of mortality in SCA patients. These three biomarkers in relation to ventricular fibrillation (VF) and asystole on scene during resuscitation has not, to our knowledge, been evaluated. Hypothesis: We hypothesized that early-on levels of hs-cTnT, copeptin and NT-proBNP may relate to prognosis. Methods: From February 2007 until November 2010 blood samples were collected from patients aged > 18 years with out-of-hospital cardiac arrest of assumed cardiac origin. EDTA-blood was drawn during or immediately after termination of cardiopulmonary resuscitation or at hospital admission. Hs-cTnT, copeptin and NT-proBNP were all measured by standardized methods. Patients were classified according to first recorded heart rhythm. Both univariate and multivariate analyses, adjusted for age and gender, were performed using a Cox Proportional-Hazards model. Results: A total of 115 patients were included, 77 patients with VF and 38 patients with asystole as first recorded heart rhythm. Forty-four patients (38,3%) survived to 30-day follow-up. There was no significant difference in hs-cTnT (p = 0.71) or copeptin (p = 0.43) between non-survivors and survivors. The mean NT-proBNP level was significantly elevated in non-survivors compared to survivors, p = 0.001. The hazard ratio (HR) in the univariate analysis for patients with NT-proBNP in the highest quartile (Q4) compared to the lowest quartile (Q1) was 4.68 (95% CI 2.05-10.68), p = < 0.001, and in the multivariate analysis HR was 2.52 (95% CI 0.97-6.53), p = 0.058. All patients in the asystole group died. Only NT-proBNP differed between the two groups, with significantly higher values in the asystole group, p = < 0.001. Conclusion: Applying hs-cTnT, copeptin and NT-proBNP for assessment of prognosis in SCA patients with either VF or asystole, only NT-proBNP was found to yield prognostic information.

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P5021Hypoperfusion markers identify patients with acute pulmonary embolism at highest risk for an adverse outcome

European Heart Journal ◽

10.1093/eurheartj/ehz746.0199 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Ebner ◽

C Sentler ◽

V P Harjola ◽

H Bueno ◽

K Keller ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cardiac Arrest ◽

High Risk ◽

Predictive Value ◽

Odds Ratio ◽

Adverse Outcome ◽

A Priori ◽

Positive Likelihood Ratio ◽

Adverse Outcomes ◽

Prognostic Information

Abstract Background/Introduction According to the European Society of Cardiology (ESC) 2014 guideline, systemic hypotension (HT) is the critical variable defining high-risk in patients with pulmonary embolism (PE). However, signs of organ hypoperfusion might more adequately identify PE patients with cardiogenic shock due to right ventricular (RV) failure. Purpose We investigated whether hypoperfusion markers provide superior prognostic information for identifying PE patients at highest risk of early adverse outcomes. Methods Consecutive PE patients enrolled in a prospective single-centre registry between 09/2008 and 03/2018 were included. We analysed the predictive value of symptoms and findings suggesting hypoperfusion for in-hospital adverse outcome (catecholamine treatment, resuscitation or PE-related death) and in-hospital all-cause mortality. Results We analysed 814 patients, including 83 (10.2%) ESC 2014 high-risk patients. Patients presenting with cardiac arrest (CA, 4.5%) were a priori defined as high risk. Markers suggesting hypoperfusion of the brain (altered metal status, odds ratio [OR] 8.2 [95% CI, 4.2–16.0]), lung (respiratory insufficiency, 25.0 [9.4–66.7]) and tissue (venous lactate ≥2.2 mmol/l, 6.4 [3.2–12.9]) as well as HT (13.5 [6.7–27.2]) predicted an adverse outcome. The risk for an adverse outcome increased with the number of positive markers (AUC 0.86 [0.80–0.93]). Patients with ≥3 positive hypoperfusion markers had an OR of 42.9 (11.0–167.3) and patients defined as high-risk by the ESC 2014 an OR of 17.2 (8.8–33.3) with regard to an adverse outcome (Figure 1; Table 1). A new definition of high-risk (CA or ≥3 hypoperfusion markers) was associated with an OR of 73.2 (31.3–171.1) for an in-hospital adverse outcome and 26.2 (12.1–56.7) for in-hospital mortality. Table 1. Prognostic performance of hypoperfusion markers Adverse outcome (if negative) Adverse outcome (if positive) Sensitivity Specificity LR+ OR (95% CI) ≥1 hypoperfusion marker 1.1% 21.0% 91.9% 68.2% 2.9 24.4 (7.3–80.8) ≥2 hypoperfusion markers 4.7% 50.0% 48.6% 95.5% 10.9 20.3 (9.1–45.1) ≥3 hypoperfusion markers 6.5% 75.0% 24.3% 99.3% 32.7 42.9 (11.0–167.3) ESC 2014 high-risk 5.7% 51.1% 35.0% 96.9% 11.4 17.2 (8.8–33.3) Cardiac arrest 8.4% 86.5% 33.0% 99.3% 47.3 70.1 (26.4–186.1) Abbreviations: LR+, positive likelihood ratio; OR, odds ratio; CI, confidence interval. Figure 1. Frequency of adverse outcome Conclusions Markers of organ hypoperfusion have high predictive value for early adverse outcomes in acute PE. Risk increases with the number of positive markers and is critically elevated in patients presenting with CA or ≥3 markers. Acknowledgement/Funding This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503).

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Prognostic value of automated pupillometry: an unselected cohort from a cardiac intensive care unit

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619842004 ◽

2019 ◽

Vol 9 (7) ◽

pp. 779-787 ◽

Cited By ~ 5

Author(s):

Laust Obling ◽

Christian Hassager ◽

Charlotte Illum ◽

Johannes Grand ◽

Sebastian Wiberg ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Intensive Care ◽

Area Under The Curve ◽

Youden Index ◽

Cardiac Intensive Care Unit ◽

Infrared Pupillometry ◽

Cardiac Intensive Care ◽

Neurological Pupil Index ◽

Hospital Cardiac Arrest

Background: Patients admitted to a cardiac intensive care unit are often unconscious with uncertain prognosis. Automated infrared pupillometry for neurological assessment in the intensive care unit may provide early prognostic information. This study aimed to determine the prognostic value of automated pupillometry in different subgroups of patients in a cardiac intensive care unit with 30-day mortality as the primary endpoint and neurological outcome as the secondary endpoint. Methods: A total of 221 comatose patients were divided into three groups: out-of-hospital cardiac arrest, in-hospital cardiac arrest and others (i.e. patients with cardiac diagnoses other than cardiac arrest). Automated pupillometry was serially performed until discharge or death and pupil measurements were analysed using the neurological pupil index algorithm. We applied receiver operating characteristic curves in univariable and multivariable logistic regression models and a calculated Youden index identified neurological pupil index cut-off values at different specificities. Results: In out-of-hospital cardiac arrest patients higher neurological pupil index values were independently associated with lower 30-day mortality. The univariable model for 30-day mortality had an area under the curve of 0.87 and the multivariable model achieved an area under the curve of 0.94. The Youden index identified a neurological pupil index cut-off in out-of-hospital cardiac arrest patients of 2.40 for a specificity of 100%. For patients with in-hospital cardiac arrest and other cardiac diagnoses, we found no association between neurological pupil index values and 30-day mortality, and the univariable models showed poor predictive values. Conclusion: Automated infrared pupillometry has promising predictive value after out-of-hospital cardiac arrest, but poor predictive value in patients with in-hospital cardiac arrest or cardiac diagnoses unrelated to cardiac arrest. Our data suggest a possible neurological pupil index cut-off of 2.40 for poor outcome in out-of-hospital cardiac arrest patients.

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Transcriptional and Metabolomic Analysis of L-Arginine/Nitric Oxide Pathway in Inflammatory Bowel Disease and Its Association with Local Inflammatory and Angiogenic Response: Preliminary Findings

International Journal of Molecular Sciences ◽

10.3390/ijms21051641 ◽

2020 ◽

Vol 21 (5) ◽

pp. 1641 ◽

Cited By ~ 3

Author(s):

Małgorzata Krzystek-Korpacka ◽

Mariusz G. Fleszar ◽

Iwona Bednarz-Misa ◽

Łukasz Lewandowski ◽

Izabela Szczuka ◽

...

Keyword(s):

Nitric Oxide ◽

Small Bowel ◽

Metabolomic Analysis ◽

Symmetric Dimethylarginine ◽

Dimethylarginine Dimethylaminohydrolase ◽

Angiogenic Potential ◽

Angiogenic Response ◽

Inflammatory Bowel ◽

Irritable Bowel ◽

Nitric Oxide Pathway

L-arginine/nitric oxide pathway in Crohn’s disease (CD) and ulcerative colitis (UC) is poorly investigated. The aim of current study is to quantify pathway serum metabolites in 52 CD (40 active), 48 UC (33 active), and 18 irritable bowel syndrome patients and 40 controls using mass spectrometry and at determining mRNA expression of pathway-associated enzymes in 91 bowel samples. Arginine and symmetric dimethylarginine decreased (p < 0.05) in active-CD (129 and 0.437 µM) compared to controls (157 and 0.494 µM) and active-UC (164 and 0.52 µM). Citrulline and dimethylamine increased (p < 0.05) in active-CD (68.7 and 70.9 µM) and active-UC (65.9 and 73.9 µM) compared to controls (42.7 and 50.4 µM). Compared to normal, CD-inflamed small bowel had downregulated (p < 0.05) arginase-2 by 2.4-fold and upregulated dimethylarginine dimethylaminohydrolase (DDAH)-2 (1.5-fold) and arginine N-methyltransferase (PRMT)-2 (1.6-fold). Quiescent-CD small bowel had upregulated (p < 0.05) arginase-2 (1.8-fold), DDAH1 (2.9-fold), DDAH2 (1.5-fold), PRMT1 (1.5-fold), PRMT2 (1.7-fold), and PRMT5 (1.4-fold). Pathway enzymes were upregulated in CD-inflamed/quiescent and UC-inflamed colon as compared to normal. Compared to inflamed, quiescent CD-colon had upregulated DDAH1 (5.7-fold) and ornithine decarboxylase (1.6-fold). Concluding, the pathway is deregulated in CD and UC, also in quiescent bowel, reflecting inflammation severity and angiogenic potential. Functional analysis of PRMTs and DDAHs as potential targets for therapy is warranted.

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Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Journal of Clinical Medicine ◽

10.3390/jcm9030744 ◽

2020 ◽

Vol 9 (3) ◽

pp. 744 ◽

Cited By ~ 4

Author(s):

Seung Ha Son ◽

In Ho Lee ◽

Jung Soo Park ◽

In Sool Yoo ◽

Seung Whan Kim ◽

...

Keyword(s):

Cardiac Arrest ◽

Neuron Specific Enolase ◽

Area Under The Curve ◽

Temperature Management ◽

Target Temperature Management ◽

High Signal ◽

Target Temperature ◽

Brain Images ◽

Prognostic Performance ◽

Hospital Cardiac Arrest

We examined whether combining biomarkers measurements and brain images early after the return of spontaneous circulation improves prognostic performance compared with the use of either biomarkers or brain images for patients with cardiac arrest following target temperature management (TTM). This retrospective observational study involved comatose out-of-hospital cardiac arrest survivors. We analyzed neuron-specific enolase levels in serum (NSE) or cerebrospinal fluid (CSF), grey-to-white matter ratio by brain computed tomography, presence of high signal intensity (HSI) in diffusion-weighted imaging (DWI), and voxel-based apparent diffusion coefficient (ADC). Of the 58 patients, 33 (56.9%) had poor neurologic outcomes. CSF NSE levels showed better prognostic performance (area under the curve (AUC) 0.873, 95% confidence interval (CI) 0.749–0.950) than serum NSE levels (AUC 0.792, 95% CI 0.644–0.888). HSI in DWI showed the best prognostic performance (AUC 0.833, 95% CI 0.711–0.919). Combining CSF NSE levels and HSI in DWI had better prognostic performance (AUC 0.925, 95% CI 0.813–0.981) than each individual method, followed by the combination of serum NSE levels and HSI on DWI and that of CSF NSE levels and the percentage of voxels of ADC (AUC 0.901, 95% CI 0.792–0.965; AUC 0.849, 95% CI 0.717–0.935, respectively). Combining CSF/serum NSE levels and HSI in DWI before TTM improved the prognostic performance compared to either each individual method or other combinations.

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Abstract 9056: The Association Between Thoracic Injuries Due to Chest Compression and Short-Term Prognosis in Patients With Non-traumatic Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.144.suppl_2.9056 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Aya Katasako ◽

Shoji Kawakami ◽

Hidenobu Koga ◽

Kenichi Kitahara ◽

Keiichiro Komiya ◽

...

Keyword(s):

Cardiac Arrest ◽

Chest Compression ◽

Survival Rates ◽

Area Under The Curve ◽

Spontaneous Circulation ◽

Rank Test ◽

Thoracic Injuries ◽

Short Term ◽

Roc Curve Analysis ◽

Hospital Cardiac Arrest

Background: The current guidelines emphasize that high-quality chest compression is essential for improving the survival in out-of-hospital cardiac arrest (OHCA) patients. However, it may lead to thoracic injuries which is a potential factor of poor prognosis. Method: Between June 2017 to July 2019, we collected Utstein-style data on 384 consecutive adult patients with non-traumatic OHCA who were transferred to our hospital. Full-body CT scan was performed and thoracic injuries were defined as rib fracture, sternum fracture, hemorrhagic pleural effusion, pneumothorax, sternum posterior bleeding, mediastinal hematoma, or mediastinal emphysema. We identified the predictors for thoracic injuries and evaluated the relationship between thoracic injuries and prognosis. Results: Patients with thoracic injuries (Group-T) were 234 (76%). The duration of chest compression in Group-T was 43 min, which was significantly longer than that in patients without thoracic injuries (Group-N, 32 min, p<0.001). ROC curve analysis identified a duration of chest compression of 35 minutes as the optimal cut off for predicting thoracic injuries (area under the curve 0.73). Multivariate analysis revealed that age (OR: 1.03, 95%CI: 1.01-1.05, p=0.005) and duration of chest compression (OR: 1.07, 95%CI: 1.04-1.09, p<0.001) were independent predictors of thoracic injuries. The rate of obtaining return of spontaneous circulation (ROSC), 30-day survival and favorable neurologic outcome were larger in Group-N than Group-T. In patients with achieving ROSC, Kaplan-Meier curves showed a significantly higher cumulative survival rates in Group-N compared to that in Group-T during follow-up of 30 days (Log-rank test p=0.009). Conclusion: Age and duration of chest compression were independent predictors for thoracic injuries due to chest compression in non-traumatic OHCA patients. Moreover, the presence of thoracic injuries was associated with poor short-term prognosis.

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Inhaled Nitric Oxide in Adults with In-Hospital Cardiac Arrest: A Feasibility Study

Nitric Oxide ◽

10.1016/j.niox.2021.07.001 ◽

2021 ◽

Author(s):

Jignesh K. Patel ◽

Elinor Schoenfeld ◽

Wei Hou ◽

Adam Singer ◽

Ewa Rakowski ◽

...

Keyword(s):

Nitric Oxide ◽

Cardiac Arrest ◽

Feasibility Study ◽

Inhaled Nitric Oxide ◽

Hospital Cardiac Arrest

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N-Terminal Pro-B-Type Natriuretic Peptide as a Prognostic Indicator for 30-Day Mortality Following Out-of-Hospital Cardiac Arrest: A prospective observational study.

10.21203/rs.3.rs-31686/v2 ◽

2020 ◽

Author(s):

Reidun Aarsetøy ◽

Torbjørn Omland ◽

Helge Røsjø ◽

Heidi Strand ◽

Thomas Werner Lindner ◽

...

Keyword(s):

Cardiac Arrest ◽

Natriuretic Peptide ◽

Troponin T ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Sudden Cardiac Arrest ◽

Cardiac Biomarkers ◽

Prognostic Information ◽

Clinical Trial Registration ◽

Hospital Cardiac Arrest

Abstract Background: Early risk stratification applying cardiac biomarkers may prove useful in sudden cardiac arrest patients. We investigated the prognostic utility of early-on levels of high sensitivity cardiac troponin-T (hs-cTnT), copeptin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with out-of-hospital cardiac arrest (OHCA).Methods: We conducted a prospective observational unicenter study, including patients with OHCA of assumed cardiac origin from the Southwestern part of Norway from 2007 until 2010. Blood samples for later measurements were drawn during cardiopulmonary resuscitation or at hospital admission. Results: A total of 114 patients were included, 37 patients with asystole and 77 patients with VF as first recorded heart rhythm. Forty-four patients (38.6%) survived 30-day follow-up. Neither hs-cTnT (p = 0.49), nor copeptin (p = 0.39) differed between non-survivors and survivors, whereas NT-proBNP was higher in non-survivors and significantly associated with time to death, with a hazard ratio (HR) for patients in the highest compared to the lowest quartile of 4.6 (95% CI 2.1 – 10.1), p < 0.001. This association was attenuated in the multivariable analysis [HR 2.18 (95% CI 0.83 – 5.72)], p = 0.11. NT-proBNP was significantly higher in asystole- as compared to VF-patients, p < 0.001.Conclusions: In OHCA, NT-proBNP was significantly associated with 30-day survival in univariate analysis, but associations were attenuated after multivariable adjustment. Hs-cTnT and copeptin did not provide prognostic information following OHCA.Clinical Trial Registration: ClinicalTrials. gov, NCT02886273.

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

Circulation ◽

10.1161/circ.130.suppl_2.251 ◽

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.

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