Abstract
Aim
Limited data suggests low oxygen consumption (VO2), driven by mitochondrial injury, is associated with mortality after cardiac arrest.
Due to the challenges of measurement in the critically ill, post-arrest metabolism
remains poorly characterized. We monitored VO2, carbon dioxide production (VCO2) and the respiratory quotient (RQ) in post-arrest patients and explored associations
with outcome.
Methods
Using a gas exchange monitor, we measured continuous VO2 and VCO2 in post- arrest patients treated with targeted temperature management. We used area
under the curve and medians over time to evaluate the association between VO2, VCO2, RQ and the VO2:lactate ratio with survival.
Results
In 17 patients, VO2 in the first 12 h after return of spontaneous circulation (ROSC) was associated with
survival (median in survivors 3.35 mL/kg/min [2.98,3.88] vs. non-survivors 2.61 mL/kg/min
[2.21,2.94], p = .039). This did not persist over 24 h. The VO2:lactate ratio was associated with survival (median in survivors 1.4 [IQR: 1.1,1.7]
vs. non-survivors 0.8 [IQR: 0.6,1.2] p < 0.001). Median RQ was 0.66 (IQR 0.63,0.70)
and 71% of RQ measurements were <0.7. Patients with initial RQ < 0.7 had 17% survival
versus 64% with initial RQ > 0.7 (p = .131). VCO2 was not associated with survival.
Conclusions
There was a significant association between VO2 and mortality in the first 12 h after ROSC, but not over 24 h. Lower VO2: lactate ratio was associated with mortality. A large percentage of patients had RQs
below physiologic norms. Further research is needed to explore whether these parameters
could have true prognostic value or be a potential treatment target.
Keywords
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Article info
Publication history
Published online: April 04, 2018
Accepted:
April 2,
2018
Received in revised form:
March 13,
2018
Received:
September 26,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
