Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: An exploratory Target Temperature Management Trial substudy

TY - JOUR

T1 - Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients

T2 - An exploratory Target Temperature Management Trial substudy

AU - Ebner, Florian

AU - Harmon, Matt B.A.

AU - Aneman, Anders

AU - Cronberg, Tobias

AU - Friberg, Hans

AU - Hassager, Christian

AU - Juffermans, Nicole

AU - Kjærgaard, Jesper

AU - Kuiper, Michael

AU - Mattsson, Niklas

AU - Pelosi, Paolo

AU - Ullén, Susann

AU - Undén, Johan

AU - Wise, Matt P.

AU - Nielsen, Niklas

PY - 2018

Y1 - 2018

N2 - 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 6months, 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 (6.0-7.30kPa) 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 72h 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.

AB - 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 6months, 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 (6.0-7.30kPa) 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 72h 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.

KW - Biomarker

KW - Carbon dioxide partial pressure

KW - Cerebral performance

KW - Out-of-hospital cardiac arrest

KW - Serum Tau

U2 - 10.1186/s13054-018-2119-5

DO - 10.1186/s13054-018-2119-5

M3 - Journal article

C2 - 30119692

AN - SCOPUS:85051973001

SN - 1364-8535

VL - 22

JO - Critical Care

JF - Critical Care

IS - 1

M1 - 196

ER -