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Relationship between arterial partial oxygen pressure after resuscitation from cardiac arrest and mortality in
Lee P Ferguson1, Andrew Durward, Shane M Tibby
1Pediatric Intensive Care Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom. lee.ferguson7@nuth.nhs.uk
Insights
Both low and high arterial oxygen levels increase the risk of death in children after cardiac arrest. Current guidelines suggest avoiding hyperoxia, but this study shows both extremes are dangerous for pediatric intensive care unit (PICU) survival.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary resuscitation outcomes
- Pediatric intensive care unit (PICU) research
Background:
- Adult studies link hyperoxia post-cardiac arrest to worse outcomes.
- Pediatric guidelines currently advise against hyperoxia, based on adult data.
- The impact of arterial oxygen levels on pediatric cardiac arrest survival is not well-established.
Purpose of the Study:
- To investigate the relationship between arterial partial pressure of oxygen (PaO2) and survival in pediatric patients following cardiac arrest.
- To determine the association between oxygenation status and mortality in the pediatric intensive care unit (PICU).
Main Methods:
- Retrospective cohort study using the Pediatric Intensive Care Audit Network (PICANet) database (2003-2010).
- Included patients aged <16 years with cardiac arrest before PICU admission and arterial blood gas analysis within 1 hour.
- Logistic regression and multivariable fractional polynomials modeled the relationship between PaO2 and PICU mortality, adjusting for covariates.
Main Results:
- A significant nonlinear relationship was found between PaO2 and PICU mortality.
- Hypoxia (PaO2 <60 mm Hg) was strongly associated with increased mortality (OR 1.92).
- Hyperoxia (PaO2 ≥300 mm Hg) was also associated with increased mortality, though less dramatically (OR 1.25).
Conclusions:
- Both severe hypoxia and hyperoxia are linked to higher death risk in children post-cardiac arrest.
- The findings suggest that optimal oxygen management in pediatric resuscitation requires careful consideration of both extremes.
- Age and congenital heart disease presence further modify mortality risk in these patients.
Background:
Observational studies in adults have shown a worse outcome associated with hyperoxia after resuscitation from cardiac arrest. Extrapolating from adult data, current pediatric resuscitation guidelines recommend avoiding hyperoxia. We investigated the relationship between arterial partial oxygen pressure and survival in patients admitted to the pediatric intensive care unit (PICU) after cardiac arrest.
Methods And Results:
We conducted a retrospective cohort study using the Pediatric Intensive Care Audit Network (PICANet) database between 2003 and 2010 (n=122,521). Patients aged <16 years with documented cardiac arrest preceding PICU admission and arterial blood gas analysis taken within 1 hour of PICU admission were included. The primary outcome measure was death within the PICU. The relationship between postarrest oxygen status and outcome was modeled with logistic regression, with nonlinearities explored via multivariable fractional polynomials. Covariates included age, sex, ethnicity, congenital heart disease, out-of-hospital arrest, year, Pediatric Index of Mortality-2 (PIM2) mortality risk, and organ supportive therapies. Of 1875 patients, 735 (39%) died in PICU. Based on the first arterial gas, 207 patients (11%) had hyperoxia (Pa(O)(2) ≥300 mm Hg) and 448 (24%) had hypoxia (Pa(O)(2) <60 mm Hg). We found a significant nonlinear relationship between Pa(O)(2) and PICU mortality. After covariate adjustment, risk of death increased sharply with increasing hypoxia (odds ratio, 1.92; 95% confidence interval, 1.80-2.21 at Pa(O)(2) of 23 mm Hg). There was also an association with increasing hyperoxia, although not as dramatic as that for hypoxia (odds ratio, 1.25; 95% confidence interval, 1.17-1.37 at 600 mm Hg). We observed an increasing mortality risk with advancing age, which was more pronounced in the presence of congenital heart disease.
Conclusions:
Both severe hypoxia and, to a lesser extent, hyperoxia are associated with an increased risk of death after PICU admission after cardiac arrest.
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