Early oxygenation and ventilation measurements after pediatric cardiac arrest: Lack of association with outcome

Kimberly Statler Bennett, Amy E. Clark, Kathleen L. Meert, Alexis A. Topjian, Charles L. Schleien, Donald Harry Shaffner, J. Michael Dean, Frank W. Moler

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To explore oxygenation and ventilation status early after cardiac arrest in infants and children. We hypothesize that hyperoxia is common and associated with worse outcome after pediatric cardiac arrest. DESIGN: Retrospective cohort study. SETTING: Fifteen hospitals within the Pediatric Emergency Care Applied Research Network. PATIENTS: Children who suffered a cardiac arrest event and survived for at least 6 hours after return of circulation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Analysis of 195 events revealed that abnormalities in oxygenation and ventilation are common during the initial 6 hours after pediatric cardiac arrest. Hyperoxia was frequent, affecting 54% of patients. Normoxia was documented in 34% and hypoxia in 22% of patients. These percentages account for a 10% overlap of patients who had both hyperoxia and hypoxia. Ventilation status was more evenly distributed with hyperventilation observed in 38%, normoventilation in 29%, and hypoventilation in 46%, with a 13% overlap of patients who had both hyperventilation and hypoventilation. Derangements in both oxygenation and ventilation were common early after cardiac arrest such that both normoxia and normocarbia were documented in only 25 patients (13%). Neither oxygenation nor ventilation status was associated with outcome. After controlling for potential confounders, arrest location and rhythm were significantly associated with worse outcome; however, hyperoxia was not (odds ratio for good outcome, 1.02 [0.46, 2.84]; p = 0.96). CONCLUSIONS: Despite recent resuscitation guidelines that advocate maintenance of normoxia and normoventilation after pediatric cardiac arrest, this is uncommonly achieved in practice. Although we did not demonstrate an association between hyperoxia and worse outcome, the small proportion of patients kept within normal ranges limited our power. Preclinical data suggesting potential harm with hyperoxia remain compelling, and further investigation, including prospective, large studies involving robust recording of physiological derangements, is necessary to further advance our understanding of this important topic.

Original languageEnglish (US)
Pages (from-to)1534-1542
Number of pages9
JournalCritical Care Medicine
Volume41
Issue number6
DOIs
StatePublished - Jun 2013

Fingerprint

Hyperoxia
Heart Arrest
Ventilation
Pediatrics
Hypoventilation
Hyperventilation
Pediatric Hospitals
Emergency Medical Services
Resuscitation
Reference Values
Cohort Studies
Retrospective Studies
Odds Ratio
Maintenance
Prospective Studies
Guidelines
Research

Keywords

  • hypercarbia
  • hyperoxia
  • hyperventilation
  • hypocarbia
  • hypoxia
  • resuscitation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Early oxygenation and ventilation measurements after pediatric cardiac arrest : Lack of association with outcome. / Bennett, Kimberly Statler; Clark, Amy E.; Meert, Kathleen L.; Topjian, Alexis A.; Schleien, Charles L.; Shaffner, Donald Harry; Dean, J. Michael; Moler, Frank W.

In: Critical Care Medicine, Vol. 41, No. 6, 06.2013, p. 1534-1542.

Research output: Contribution to journalArticle

Bennett, Kimberly Statler ; Clark, Amy E. ; Meert, Kathleen L. ; Topjian, Alexis A. ; Schleien, Charles L. ; Shaffner, Donald Harry ; Dean, J. Michael ; Moler, Frank W. / Early oxygenation and ventilation measurements after pediatric cardiac arrest : Lack of association with outcome. In: Critical Care Medicine. 2013 ; Vol. 41, No. 6. pp. 1534-1542.
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abstract = "OBJECTIVES: To explore oxygenation and ventilation status early after cardiac arrest in infants and children. We hypothesize that hyperoxia is common and associated with worse outcome after pediatric cardiac arrest. DESIGN: Retrospective cohort study. SETTING: Fifteen hospitals within the Pediatric Emergency Care Applied Research Network. PATIENTS: Children who suffered a cardiac arrest event and survived for at least 6 hours after return of circulation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Analysis of 195 events revealed that abnormalities in oxygenation and ventilation are common during the initial 6 hours after pediatric cardiac arrest. Hyperoxia was frequent, affecting 54{\%} of patients. Normoxia was documented in 34{\%} and hypoxia in 22{\%} of patients. These percentages account for a 10{\%} overlap of patients who had both hyperoxia and hypoxia. Ventilation status was more evenly distributed with hyperventilation observed in 38{\%}, normoventilation in 29{\%}, and hypoventilation in 46{\%}, with a 13{\%} overlap of patients who had both hyperventilation and hypoventilation. Derangements in both oxygenation and ventilation were common early after cardiac arrest such that both normoxia and normocarbia were documented in only 25 patients (13{\%}). Neither oxygenation nor ventilation status was associated with outcome. After controlling for potential confounders, arrest location and rhythm were significantly associated with worse outcome; however, hyperoxia was not (odds ratio for good outcome, 1.02 [0.46, 2.84]; p = 0.96). CONCLUSIONS: Despite recent resuscitation guidelines that advocate maintenance of normoxia and normoventilation after pediatric cardiac arrest, this is uncommonly achieved in practice. Although we did not demonstrate an association between hyperoxia and worse outcome, the small proportion of patients kept within normal ranges limited our power. Preclinical data suggesting potential harm with hyperoxia remain compelling, and further investigation, including prospective, large studies involving robust recording of physiological derangements, is necessary to further advance our understanding of this important topic.",
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AU - Schleien, Charles L.

AU - Shaffner, Donald Harry

AU - Dean, J. Michael

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