Clinical paper| Volume 127, P89-94, June 2018

Preliminary observations in systemic oxygen consumption during targeted temperature management after cardiac arrest



      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.


      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ayoub I.M.
        • Radhakrishnan J.
        • Gazmuri R.J.
        Targeting mitochondria for resuscitation from cardiac arrest.
        Crit Care Med. 2008; 36: S440-S446
        • Rivers E.P.
        • Rady M.Y.
        • Martin G.B.
        • Fenn N.M.
        • Smithline H.A.
        • Alexander M.E.
        • et al.
        Venous hyperoxia after cardiac arrest. Characterization of a defect in systemic oxygen utilization.
        Chest. 1992; 102: 1787-1793
        • Hayes M.A.
        • Yau E.H.
        • Timmins A.C.
        • Hinds C.J.
        • Watson D.
        Response of critically ill patients to treatment aimed at achieving supranormal oxygen delivery and consumption.
        Chest. 1993; 103: 886-895
        • Hayes M.A.
        • Timmins A.C.
        • Yau E.
        • Palazzo M.
        • Hinds C.J.
        • Watson D.
        Elevation of systemic oxygen delivery in the treatment of critically ill patients.
        N Engl J Med. 1994; 16 (June 16): 1717-1722
        • Fink M.P.
        Bench-to-bedside review: cytopathic hypoxia.
        Crit Care. 2002; 6: 491-499
        • Vandermeer T.J.
        • Wang H.
        • Fink M.P.
        Endotoxemia causes ileal mucosal acidosis in the absence of mucosal hypoxia in a normodynamic porcine model of septic shock.
        Crit Care Med. 1995; 23: 1217-1226
        • Rosser D.M.
        • Stidwill R.P.
        • Jacobson D.
        • Singer M.
        Oxygen tension in the bladder epithelium rises in both high and low cardiac output endotoxemic sepsis.
        J Appl Physiol. 1995; 79: 1878-1882
        • Astiz M.
        • Rackow E.C.
        • Weil M.H.
        • Schumer W.
        Early impairment of oxidative metabolism and energy production in severe sepsis.
        Circ Shock. 1988; 26: 311-320
        • Oshima T.
        • Furukawa Y.
        • Kobayashi M.
        • Sato Y.
        • Nihei A.
        • Oda S.
        Fulfilling caloric demands according to indirect calorimetry may be beneficial for post cardiac arrest patients under therapeutic hypothermia.
        Resuscitation. 2015; 88: 81-85
        • Holzinger U.
        • Brunner R.
        • Losert H.
        • Fuhrmann V.
        • Herkner H.
        • Madl C.
        • et al.
        Resting energy expenditure and substrate oxidation rates correlate to temperature and outcome after cardiac arrest – a prospective observational cohort study.
        Crit Care. 2015; 29: 128
        • McLellan S.
        • Walsh T.S.
        • Burdess A.
        • Lee A.
        Comparison between the Datex-Ohmeda M-COVX metabolic monitor and the Deltatrac II in mechanically ventilated patients.
        Intensive Care Med. 2002; 28: 870-876
        • Donaldson L.
        • Dodd S.
        • Walsh T.S.
        Clinical evaluation of a continuous oxygen consumption monitor in mechanically ventilated patients.
        Anaesthesia. 2003; 58: 455-460
        • Nolan J.P.
        • Neumar R.W.
        • Adrie C.
        • Aibiki M.
        • Berg R.A.
        • Bbttiger B.W.
        • et al.
        Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A scientific statement from the international liaison committee on resuscitation; the american heart association emergency cardiovascular care committee; the council on cardiovascular surgery and anesthesia; the council on cardiopulmonary, perioperative, and critical care; the council on clinical cardiology; the council on stroke.
        Resuscitation. 2008; 79: 350-379
        • Donnino M.W.
        • Liu X.
        • Andersen L.W.
        • Rittenberger J.C.
        • Abella B.S.
        • Gaieski D.F.
        • et al.
        Characterization of mitochondrial injury after cardiac arrest (COMICA).
        Resuscitation. 2017; 113: 56-62
        • Halestrap A.P.
        • Clarke S.J.
        • Javadov S.A.
        Mitochondrial permeability transition pore opening during myocardial reperfusion–a target for cardioprotection.
        Cardiovasc Res. 2004; 15 (Feb 15): 372-385
        • Schutz Y.
        • Ravussin E.
        Respiratory quotients lower than 0.70 in ketogenic diets.
        Am J Clin Nutr. 1980; 33: 1317-1319
        • Koch C.J.
        • Biaglow J.E.
        Cyanide insensitive respiration in mammalian cells: an artifact of mycoplasmal contamination.
        Adv Exp Med Biol. 1983; 159: 337-345
        • Kantrow S.P.
        • Taylor D.E.
        • Carraway M.S.
        • Piantadosi C.A.
        Oxidative metabolism in rat hepatocytes and mitochondria during sepsis.
        Arch Biochem Biophys. 1997; 345 (Sep 15): 278-288