Hyperoxia after pediatric cardiac arrest: Association with survival and neurological outcomes
Jessica A Barreto1, Noel S Weiss2, Katie R Nielsen3
1Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, United States.
Insights
Hyperoxia, or high oxygen levels, after pediatric cardiac arrest is common. This study found no association between hyperoxia and in-hospital mortality or poor neurological outcomes in children.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular research
- Neurology
Background:
- Hyperoxia, defined as elevated blood oxygen levels, is frequently observed in children following in-hospital cardiac arrest.
- The clinical significance of hyperoxia in this vulnerable population remains unclear.
Purpose of the Study:
- To investigate the association between hyperoxia in the first 24 hours post-pediatric cardiac arrest and in-hospital mortality.
- To evaluate the relationship between hyperoxia and neurological outcomes in pediatric patients after cardiac arrest.
Main Methods:
- Retrospective cohort study of 187 pediatric inpatients (age <18) who experienced cardiac arrest and achieved return of circulation.
- Hyperoxia defined as PaO2 > 200 mmHg within 24 hours of return of circulation; outcomes assessed included in-hospital mortality and neurological status.
- Sensitivity analyses performed using different PaO2 thresholds and SpO2 levels to assess the robustness of findings.
Main Results:
- 48% of eligible pediatric patients experienced hyperoxia within 24 hours of return of circulation.
- In-hospital mortality was 41%, with no significant difference observed between hyperoxia and normoxia groups (45% vs. 38%).
- Adjusted analyses revealed no association between hyperoxia and in-hospital mortality or poor neurological outcome (OR 1.2, 95% CI 0.5-2.8).
Conclusions:
- Hyperoxia is a common occurrence in children following in-hospital cardiac arrest.
- The study did not find evidence to support an association between hyperoxia and adverse in-hospital outcomes, including mortality and neurological deficits.
- These findings suggest that hyperoxia may not be detrimental in the early post-cardiac arrest period in pediatric patients.
Objective:
To evaluate the association between hyperoxia in the first 24 hours after in-hospital pediatric cardiac arrest and mortality and poor neurological outcome.
Methods:
This is a retrospective cohort study of inpatients in a freestanding children's hospital. We included all patients younger than 18 years of age with in-hospital cardiac arrest between December 2012 and December 2019, who achieved return of circulation (ROC) for longer than 20 minutes, survived at least 24 hours after cardiac arrest, and had documented PaO2 or SpO2 during the first 24 hours after ROC. Hyperoxia was defined as having at least one level of PaO2 above 200 mmHg in the first 24 hours after cardiac arrest.
Results:
There were 187 patients who met eligibility criteria, of whom 48% had hyperoxia during the first 24 hours after cardiac arrest. In-hospital mortality was 41%, with similar mortality between oxygenation groups (hyperoxia 45% vs no hyperoxia 38%). We did not observe an association between hyperoxia and in-hospital mortality or poor neurological outcome after adjusting for confounders (odds ratio 1.2, 95% confidence interval 0.5-2.8). On sensitivity analysis using two additional cutoffs of PaO2 (>150 mmHg and > 300 mmHg), there was also no association with in-hospital mortality or poor neurological outcome after adjusting for confounders. Similarly, on multivariable logistic regression using SpO2 > 99% as the exposure, there was no difference in the frequency of death or poor neurological outcome at hospital discharge.
Conclusion:
Hyperoxia after pediatric cardiac arrest was common and was not associated with worse in-hospital outcomes.
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