Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
BMC Cardiovasc Disord. 2022 Apr 11;22(1):163. doi: 10.1186/s12872-022-02598-6.
To investigate the impact of hyperoxia that developed immediately after extracorporeal membrane oxygenation (ECMO)-assisted cardiopulmonary resuscitation (ECPR) on patients' short-term neurological outcomes after out-of-hospital cardiac arrest (OHCA).
This study retrospectively analyzed data from the Japanese OHCA registry from June 2014 to December 2017. We analyzed adult patients (≥ 18 years) who had undergone ECPR. Eligible patients were divided into the following three groups based on their initial partial pressure of oxygen in arterial blood (PaO) levels after ECMO pump-on: normoxia group, PaO ≤ 200 mm Hg; moderate hyperoxia group, 200 mm Hg < PaO ≤ 400 mm Hg; and extreme hyperoxia group, PaO > 400 mm Hg. The primary and secondary outcomes were 30-day favorable neurological outcomes. Logistic regression statistical analysis model of 30-day favorable neurological outcomes was performed after adjusting for multiple propensity scores calculated using pre-ECPR covariates and for confounding factors post-ECPR.
Of the 34,754 patients with OHCA enrolled in the registry, 847 were included. The median PaO level was 300 mm Hg (interquartile range: 148-427 mm Hg). Among the eligible patients, 277, 313, and 257 were categorized as normoxic, moderately hyperoxic, and extremely hyperoxic, respectively. Moderate hyperoxia was not significantly associated with 30-day neurologically favorable outcomes compared with normoxia as a reference (adjusted odds ratio, 0.86; 95% confidence interval: 0.55-1.35; p = 0.51). However, extreme hyperoxia was associated with less 30-day neurologically favorable outcomes when compared with normoxia (adjusted odds ratio, 0.48; 95% confidence interval: 0.29-0.82; p = 0.007).
For patients with OHCA who received ECPR, extreme hyperoxia (PaO > 400 mm Hg) was associated with 30-day poor neurological outcomes. Avoidance of extreme hyperoxia may improve neurological outcomes in patients with OHCA treated with ECPR.
本研究旨在探讨体外膜肺氧合（ECMO）辅助心肺复苏（CPR）后即刻发生的高氧血症对院外心脏骤停（OHCA）患者短期神经结局的影响。
本研究回顾性分析了 2014 年 6 月至 2017 年 12 月日本 OHCA 注册中心的数据。我们分析了接受 ECPR 的成年患者（≥18 岁）。根据 ECMO 泵启动后动脉血氧分压（PaO2）初始水平，将符合条件的患者分为以下三组：氧合正常组，PaO2≤200mmHg；中度高氧组，200mmHg<PaO2≤400mmHg；极度高氧组，PaO2>400mmHg。主要和次要结局为 30 天良好的神经功能结局。对多个使用预 ECPR 协变量和 ECPR 后混杂因素计算的倾向评分进行调整后，对 30 天良好神经功能结局进行 logistic 回归统计分析模型。
在登记处纳入的 34754 例 OHCA 患者中，847 例患者符合条件。中位 PaO2 水平为 300mmHg（四分位间距：148-427mmHg）。在符合条件的患者中，277 例、313 例和 257 例分别归类为氧合正常、中度高氧和极度高氧。与正常氧合相比，中度高氧与 30 天神经功能良好结局无显著相关性（调整比值比，0.86；95%置信区间：0.55-1.35；p=0.51）。然而，与正常氧合相比，极度高氧与 30 天神经功能不良结局显著相关（调整比值比，0.48；95%置信区间：0.29-0.82；p=0.007）。
对于接受 ECPR 的 OHCA 患者，极度高氧血症（PaO2>400mmHg）与 30 天不良神经结局相关。避免极度高氧血症可能会改善接受 ECPR 治疗的 OHCA 患者的神经结局。
