Hyperoxia, hypocapnia and hypercapnia as outcome factors after cardiac arrest in children

Abstract Purpose Arterial hyperoxia after resuscitation has been associated with increased mortality in adults. The aim of this study was to test the hypothesis that post-resuscitation hyperoxia and hypocapnia are associated with increased mortality after resuscitation in pediatric patients. Methods...

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Bibliographic Details
Published in:Resuscitation 2012-12, Vol.83 (12), p.1456-1461
Main Authors: del Castillo, Jimena, López-Herce, Jesús, Matamoros, Martha, Cañadas, Sonia, Rodriguez-Calvo, Ana, Cechetti, Corrado, Rodriguez-Núñez, Antonio, Álvarez, Angel Carrillo
Format: Article
Language:English
Subjects:
Adolescent
Cardiac arrest
Cardiopulmonary Resuscitation
Child
Child, Preschool
Children
Emergency
Female
Heart Arrest - complications
Heart Arrest - mortality
Heart Arrest - therapy
Humans
Hypercapnia
Hypercapnia - epidemiology
Hypercapnia - etiology
Hyperoxia
Hyperoxia - epidemiology
Hyperoxia - etiology
Hypocapnia
Hypocapnia - epidemiology
Hypocapnia - etiology
Hypoxia
Incidence
Infant
Male
Prospective Studies
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Summary:Abstract Purpose Arterial hyperoxia after resuscitation has been associated with increased mortality in adults. The aim of this study was to test the hypothesis that post-resuscitation hyperoxia and hypocapnia are associated with increased mortality after resuscitation in pediatric patients. Methods We performed a prospective observational multicenter hospital-based study including 223 children aged between 1 month and 18 years who achieved return of spontaneous circulation after in-hospital cardiac arrest and for whom arterial blood gas analysis data were available. Results After return of spontaneous circulation, 8.5% of patients had hyperoxia (defined as PaO2 > 300 mmHg) and 26.5% hypoxia (defined as PaO2 < 60 mmHg). No statistical differences in mortality were observed when patients with hyperoxia (52.6%), hypoxia (42.4%), or normoxia (40.7%) ( p = 0.61). Hypocapnia (defined as PaCO2 < 30 mmHg) was observed in 13.5% of patients and hypercapnia (defined as PaCO2 > 50 mmHg) in 27.6%. Patients with hypercapnia or hypocapnia had significantly higher mortality (59.0% and 50.0%, respectively) than patients with normocapnia (33.1%) ( p = 0.002). At 24 h after return of spontaneous circulation, neither PaO2 nor PaCO2 values were associated with mortality. Multiple logistic regression analysis showed that hypercapnia (OR, 3.27; 95% CI, 1.62–6.61; p = 0.001) and hypocapnia (OR, 2.71; 95% CI, 1.04–7.05; p = 0.04) after return of spontaneous circulation were significant mortality factors. Conclusions In children resuscitated from cardiac arrest, hyperoxemia after return of spontaneous circulation or 24 h later was not associated with mortality. On the other hand, hypercapnia and hypocapnia were associated with higher mortality than normocapnia.
ISSN:0300-9572
1873-1570
DOI:10.1016/j.resuscitation.2012.07.019