Association of Pediatric Postcardiac Arrest Ventilation and Oxygenation with Survival Outcomes
Aisha H. Frazier, Alexis Topjian, Ron Reeder, Ryan W. Morgan, Ericka L. Fink, Deborah Franzon, Kathryn Graham, Monica Harding, Peter M. Mourani, Vinay Nadkarni, Heather Wolfe, Tageldin Ahmed, Michael J. Bell, Candice Burns, Joseph A. Carcillo, Todd C. Carpenter, J. Wesley Diddle, Myke Federman, Stuart H. Friess, Mark W. Hall, David A. Hehir, Christopher M. Horvat, Leanna L. Huard, Tensing Maa, Kathleen L. Meert, Maryam Y. Naim, Daniel A. Notterman, Murray M. Pollack, Carleen Schneiter, Matthew Sharron, Neeraj Srivastava, Shirley Viteri, David Wessel, Andrew R. Yates, Robert M Sutton, Robert A. Berg
Abstract
Abstract Rationale Adult and pediatric studies provide conflicting data regarding whether post–cardiac arrest hypoxemia, hyperoxemia, hypercapnia, and/or hypocapnia are associated with worse outcomes. Objectives We sought to determine whether postarrest hypoxemia or postarrest hyperoxemia is associated with lower rates of survival to hospital discharge, compared with postarrest normoxemia, and whether postarrest hypocapnia or hypercapnia is associated with lower rates of survival, compared with postarrest normocapnia. Methods An embedded prospective observational study during a multicenter interventional cardiopulmonary resuscitation trial was conducted from 2016 to 2021. Patients ⩽18 years old and with a corrected gestational age of ≥37 weeks who received chest compressions for cardiac arrest in one of the 18 intensive care units were included. Exposures during the first 24 hours postarrest were hypoxemia, hyperoxemia, or normoxemia—defined as lowest arterial oxygen tension/pressure (PaO2) <60 mm Hg, highest PaO2 ⩾200 mm Hg, or every PaO2 60–199 mm Hg, respectively—and hypocapnia, hypercapnia, or normocapnia, defined as lowest arterial carbon dioxide tension/pressure (PaCO2) <30 mm Hg, highest PaCO2 ⩾50 mm Hg, or every PaCO2 30–49 mm Hg, respectively. Associations of oxygenation and carbon dioxide group with survival to hospital discharge were assessed using Poisson regression with robust error estimates. Results The hypoxemia group was less likely to survive to hospital discharge, compared with the normoxemia group (adjusted relative risk [aRR] = 0.71; 95% confidence interval [CI] = 0.58–0.87), whereas survival in the hyperoxemia group did not differ from that in the normoxemia group (aRR = 1.0; 95% CI = 0.87–1.15). The hypercapnia group was less likely to survive to hospital discharge, compared with the normocapnia group (aRR = 0.74; 95% CI = 0.64–0.84), whereas survival in the hypocapnia group did not differ from that in the normocapnia group (aRR = 0.91; 95% CI = 0.74–1.12). Conclusions Postarrest hypoxemia and hypercapnia were each associated with lower rates of survival to hospital discharge.