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Outcomes associated with intra-arrest hyperoxaemia in out-of-hospital cardiac arrest: A registry-based cohort study

  • Junichi Izawa
    Correspondence
    Corresponding author at: Department of Preventive Services, Kyoto University School of Public Health Yoshida-konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
    Affiliations
    Department of Preventive Services, Kyoto University School of Public Health Yoshida-konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan

    Division of Critical Care Medicine, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Uruma, 281 Miyazato, Uruma, Okinawa 904-2293, Japan
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  • Sho Komukai
    Affiliations
    Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, 1-1 Yamada-oka, Suita, Osaka 565-0871, Japan
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  • Norihiro Nishioka
    Affiliations
    Department of Preventive Services, Kyoto University School of Public Health Yoshida-konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
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  • Takeyuki Kiguchi
    Affiliations
    Critical Care and Trauma Center, Osaka General Medical Center, 3-1-56 Bandai-higashi, Sumiyoshi-ku, Osaka 558-8558, Japan
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  • Tetsuhisa Kitamura
    Affiliations
    Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 1-1 Yamada-oka, Suita, Osaka 565-0871, Japan
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  • Taku Iwami
    Affiliations
    Department of Preventive Services, Kyoto University School of Public Health Yoshida-konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
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      Abstract

      Background

      An association between post-arrest hyperoxaemia and worse outcomes has been reported for out-of-hospital cardiac arrest (OHCA) patients, but little is known about the relationship between intra-arrest hyperoxaemia and clinically relevant outcomes. This study aimed to investigate the association between intra-arrest hyperoxaemia and outcomes for OHCA patients.

      Methods

      This was an observational study using a registry database of OHCA cases that occurred between 2014 and 2017 in Japan. We included adult, non-traumatic OHCA patients who were in cardiac arrest at the time of hospital arrival and for whom partial pressure of arterial oxygen (PaO2) levels was measured during resuscitation. Main exposure was intra-arrest PaO2 level, which was divided into three categories: hypoxaemia, PaO2 < 60 mmHg; normoxaemia, 60–300; or hyperoxaemia, ≥300. Primary outcome was favourable functional survival at one month or at hospital discharge. Multivariable logistic regression was performed to adjust for clinically relevant variables.

      Results

      Among 16,013 patients who met the eligibility criteria, the proportion of favourable functional survival increased as the PaO2 categories became higher: 0.5 % (57/11,484) in hypoxaemia, 1.1 % (48/4243) in normoxaemia, and 5.2 % (15/286) in hyperoxaemia (p-value for trend < 0.001). Higher PaO2 categories were associated with favourable functional survival and the adjusted odds ratios increased as the PaO2 categories became higher: 2.09 (95 % CI: 1.39–3.14) in normoxaemia and 5.04 (95 % CI: 2.62–9.70) in hyperoxaemia when compared to hypoxaemia as a reference.

      Conclusion

      In this observational study of adult OHCA patients, intra-arrest normoxaemia and hyperoxaemia were associated with better functional survival, compared to hypoxaemia.

      Keywords

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