Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients

An exploratory Target Temperature Management Trial substudy

Florian Ebner, Matt B.A. Harmon, Anders Aneman, Tobias Cronberg, Hans Friberg, Christian Hassager, Nicole Juffermans, Jesper Kjærgaard, Michael Kuiper, Niklas Mattsson, Paolo Pelosi, Susann Ullén, Johan Undén, Matt P. Wise, Niklas Nielsen

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Dyscarbia is common in out-of-hospital cardiac arrest (OHCA) patients and its association to neurological outcome is undetermined. Methods: This is an exploratory post-hoc substudy of the Target Temperature Management (TTM) trial, including resuscitated OHCA patients, investigating the association between serial measurements of arterial partial carbon dioxide pressure (PaCO2) and neurological outcome at 6months, defined by the Cerebral Performance Category (CPC) scale, dichotomized to good outcome (CPC 1 and 2) and poor outcome (CPC 3-5). The effects of hypercapnia and hypocapnia, and the time-weighted mean PaCO2 and absolute PaCO2 difference were analyzed. Additionally, the association between mild hypercapnia (6.0-7.30kPa) and neurological outcome, its interaction with target temperature (33°C and 36°C), and the association between PaCO2 and peak serum-Tau were evaluated. Results: Of the 939 patients in the TTM trial, 869 were eligible for analysis. Ninety-six percent of patients were exposed to hypocapnia or hypercapnia. None of the analyses indicated a statistical significant association between PaCO2 and neurological outcome (P=0.13-0.96). Mild hypercapnia was not associated with neurological outcome (P=0.78) and there was no statistically significant interaction with target temperature (P interaction=0.95). There was no association between PaCO2 and peak serum-Tau levels 48 or 72h after return of spontaneous circulation (ROSC). Conclusions: Dyscarbia is common after ROSC. No statistically significant association between PaCO2 in the post-cardiac arrest phase and neurological outcome at 6 months after cardiac arrest was detected. There was no significant interaction between mild hypercapnia and temperature in relation to neurological outcome.

Original languageEnglish
Article number196
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - Aug 18 2018

Fingerprint

Out-of-Hospital Cardiac Arrest
Hypercapnia
Carbon Dioxide
Temperature
Hypocapnia
Heart Arrest
Serum
Pressure

Keywords

  • Biomarker
  • Carbon dioxide partial pressure
  • Cerebral performance
  • Out-of-hospital cardiac arrest
  • Serum Tau

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients : An exploratory Target Temperature Management Trial substudy. / Ebner, Florian; Harmon, Matt B.A.; Aneman, Anders; Cronberg, Tobias; Friberg, Hans; Hassager, Christian; Juffermans, Nicole; Kjærgaard, Jesper; Kuiper, Michael; Mattsson, Niklas; Pelosi, Paolo; Ullén, Susann; Undén, Johan; Wise, Matt P.; Nielsen, Niklas.

In: Critical Care, Vol. 22, No. 1, 196, 18.08.2018.

Research output: Contribution to journalArticle

Ebner, F, Harmon, MBA, Aneman, A, Cronberg, T, Friberg, H, Hassager, C, Juffermans, N, Kjærgaard, J, Kuiper, M, Mattsson, N, Pelosi, P, Ullén, S, Undén, J, Wise, MP & Nielsen, N 2018, 'Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: An exploratory Target Temperature Management Trial substudy', Critical Care, vol. 22, no. 1, 196. https://doi.org/10.1186/s13054-018-2119-5
Ebner, Florian ; Harmon, Matt B.A. ; Aneman, Anders ; Cronberg, Tobias ; Friberg, Hans ; Hassager, Christian ; Juffermans, Nicole ; Kjærgaard, Jesper ; Kuiper, Michael ; Mattsson, Niklas ; Pelosi, Paolo ; Ullén, Susann ; Undén, Johan ; Wise, Matt P. ; Nielsen, Niklas. / Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients : An exploratory Target Temperature Management Trial substudy. In: Critical Care. 2018 ; Vol. 22, No. 1.
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AU - Aneman, Anders

AU - Cronberg, Tobias

AU - Friberg, Hans

AU - Hassager, Christian

AU - Juffermans, Nicole

AU - Kjærgaard, Jesper

AU - Kuiper, Michael

AU - Mattsson, Niklas

AU - Pelosi, Paolo

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AU - Undén, Johan

AU - Wise, Matt P.

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N2 - Background: Dyscarbia is common in out-of-hospital cardiac arrest (OHCA) patients and its association to neurological outcome is undetermined. Methods: This is an exploratory post-hoc substudy of the Target Temperature Management (TTM) trial, including resuscitated OHCA patients, investigating the association between serial measurements of arterial partial carbon dioxide pressure (PaCO2) and neurological outcome at 6months, defined by the Cerebral Performance Category (CPC) scale, dichotomized to good outcome (CPC 1 and 2) and poor outcome (CPC 3-5). The effects of hypercapnia and hypocapnia, and the time-weighted mean PaCO2 and absolute PaCO2 difference were analyzed. Additionally, the association between mild hypercapnia (6.0-7.30kPa) and neurological outcome, its interaction with target temperature (33°C and 36°C), and the association between PaCO2 and peak serum-Tau were evaluated. Results: Of the 939 patients in the TTM trial, 869 were eligible for analysis. Ninety-six percent of patients were exposed to hypocapnia or hypercapnia. None of the analyses indicated a statistical significant association between PaCO2 and neurological outcome (P=0.13-0.96). Mild hypercapnia was not associated with neurological outcome (P=0.78) and there was no statistically significant interaction with target temperature (P interaction=0.95). There was no association between PaCO2 and peak serum-Tau levels 48 or 72h after return of spontaneous circulation (ROSC). Conclusions: Dyscarbia is common after ROSC. No statistically significant association between PaCO2 in the post-cardiac arrest phase and neurological outcome at 6 months after cardiac arrest was detected. There was no significant interaction between mild hypercapnia and temperature in relation to neurological outcome.

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KW - Serum Tau

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