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Arterial hyperoxia increased in-hospital mortality following resuscitation

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Arterial hyperoxia was independently associated with increased in-hospital mortality vs. either hypoxia or normoxia in patients admitted to the ICU following resuscitation from cardiac arrest, indicated study data.

Researchers for the multicenter cohort study used the Project IMPACT critical care database of ICUs at 120 U.S. hospitals between 2001 and 2005. Inclusion criteria included age >17 years; nontraumatic cardiac arrest; cardiopulmonary resuscitation within 24 hours prior to ICU arrival; and arterial blood gas analysis performed within 24 hours following arrival at the ICU. Researchers divided patients into three groups defined a priori based on PaO₂ on the first arterial blood gas values obtained in the ICU. Hyperoxia was defined as PaO₂≥300 mm Hg; hypoxia, PaO₂ <60 mm Hg; and normoxia, not classified as hyperoxia or hypoxia.

Of the total 6,326 patients, 1,156 (18%) had hyperoxia, 3,999 (63%) had hypoxia, and 1,171 (19%) had normoxia. Hyperoxia patients had the highest in-hospital mortality (63%; n=732), followed by hypoxia (57%; n=2,297) and normoxia (45%; n=532). In a model controlling for potential confounders such as age, preadmission functional status, comorbid conditions, vital signs and other physiological indices, hyperoxia exposure had a mortality OR of 1.8 (95% CI, 1.5-2.2).

“We found that exposure to hyperoxia is a common occurrence and an independent predictor of in-hospital mortality,” researchers noted. “These data support the hypothesis that post-resuscitation hyperoxia could be harmful and provide scientific rationale for clinical trials of controlled reoxygenation during the post-resuscitation period.”

In accompanying editorial, Patrick M. Kochanek, MD, and Hülya Bayir, MD, of the University of Pittsburgh School of Medicine, said that while the study results provided valuable information regarding the administration of 100% oxygen either during or early after resuscitation, that more research is necessary before definitive recommendations can be created.

“The work of Kilgannon, et al provides an impetus for better defining the use of oxygen in all settings of cerebral resuscitation, in further exploring these revolutionary approaches to resuscitation and in examining other strategies such as the combination of 100% oxygen with antioxidant therapy or the use of targeted mitochondrial antioxidants,” they wrote.

Kilgannon JH. JAMA. 2010; 303:2165-2171.