Holmberg Mathias J, Ikeyama Takanari, Garg Rakesh, Drennan Ian R, Lavonas Eric J, Bray Janet E, Olasveengen Theresa M, Berg Katherine M
Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Center for Pediatric Emergency and Critical Care Medicine, Aichi Children's Health and Medical Center, Aichi, Japan; Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Resuscitation. 2025 Jun;211:110620. doi: 10.1016/j.resuscitation.2025.110620. Epub 2025 Apr 23.
To perform an updated systematic review and meta-analysis of oxygen and carbon dioxide targets in patients with sustained return of spontaneous circulation after cardiac arrest.
Searches were conducted in MEDLINE, Embase, and Evidence-Based Medicine Reviews from August 2019 to March 2025 for randomised trials comparing specific oxygen or carbon dioxide targets in post-cardiac arrest patients. Two investigators independently reviewed trials for relevance, extracted data, and assessed risk of bias. Data were pooled using random-effects models. The certainty of evidence was evaluated using GRADE methodology.
Fifteen manuscripts from 12 trials were included. All trials were limited to adult patients, primarily including out-of-hospital cardiac arrests. Five trials evaluated oxygen targets in the prehospital setting, while six evaluated oxygen targets and three evaluated carbon dioxide targets in the intensive care unit setting. Risk of bias was assessed as moderate for most outcomes. Meta-analyses found no differences in survival or favourable functional outcomes when comparing restrictive to liberal oxygen targets in either setting. There was also no difference in outcomes when comparing mild hypercapnia to normocapnia. The certainty of evidence was rated as low to moderate.
Among patients resuscitated from cardiac arrest, neither restrictive oxygen targets nor mild hypercapnia, compared to conventional targets, improved survival or functional outcomes.
对心脏骤停后自主循环持续恢复患者的氧和二氧化碳目标进行更新的系统评价和荟萃分析。
于2019年8月至2025年3月在MEDLINE、Embase和循证医学评价中进行检索，以查找比较心脏骤停后患者特定氧或二氧化碳目标的随机试验。两名研究人员独立审查试验的相关性、提取数据并评估偏倚风险。使用随机效应模型汇总数据。采用GRADE方法评估证据的确定性。
纳入了来自12项试验的15篇手稿。所有试验均限于成年患者，主要包括院外心脏骤停患者。5项试验在院前环境中评估了氧目标，6项试验在重症监护病房环境中评估了氧目标，3项试验在重症监护病房环境中评估了二氧化碳目标。大多数结局的偏倚风险评估为中度。荟萃分析发现，在任何一种环境中，将限制性氧目标与宽松氧目标进行比较时，生存或良好功能结局均无差异。将轻度高碳酸血症与正常碳酸血症进行比较时，结局也无差异。证据的确定性评为低到中度。
在心脏骤停复苏的患者中，与传统目标相比，限制性氧目标和轻度高碳酸血症均未改善生存或功能结局。
