Partial pressure of arterial carbon dioxide after resuscitation from cardiac arrest and neurological outcome: A prospective multi-center protocol-directed cohort study

J. Hope Kilgannon, Benton R. Hunter, Michael A. Puskarich, Lisa Shea, Brian M. Fuller, Christopher Jones, Michael Donnino, Jeffrey A. Kline, Alan E. Jones, Nathan I. Shapiro, Benjamin S. Abella, Stephen Trzeciak, Brian W. Roberts

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Aims: Partial pressure of arterial carbon dioxide (PaCO 2 ) is a regulator of cerebral blood flow after brain injury. We sought to test the association between PaCO 2 after resuscitation from cardiac arrest and neurological outcome. Methods: A prospective protocol-directed cohort study across six hospitals. Inclusion criteria: age ≥18, non-traumatic cardiac arrest, mechanically ventilated after return of spontaneous circulation (ROSC), and receipt of targeted temperature management. Per protocol, PaCO 2 was measured by arterial blood gas analyses at one and six hours after ROSC. We determined the mean PaCO 2 over this initial six hours after ROSC. The primary outcome was good neurological function at hospital discharge, defined a priori as a modified Rankin Scale ≤3. Multivariable Poisson regression analysis was used to test the association between PaCO 2 and neurological outcome. Results: Of the 280 patients included, the median (interquartile range) PaCO 2 was 44 (37–52) mmHg and 30% had good neurological function. We found mean PaCO 2 had a quadratic (inverted “U” shaped) association with good neurological outcome, with a mean PaCO 2 of 68 mmHg having the highest predictive probability of good neurological outcome, and worse neurological outcome at higher and lower PaCO 2 . Presence of metabolic acidosis attenuated the association between PaCO 2 and good neurological outcome, with a PaCO 2 of 51 mmHg having the highest predictive probability of good neurological outcome among patients with metabolic acidosis. Conclusion: PaCO 2 has a “U” shaped association with neurological outcome, with mild to moderate hypercapnia having the highest probability of good neurological outcome.

Original languageEnglish (US)
Pages (from-to)212-220
Number of pages9
JournalResuscitation
Volume135
DOIs
StatePublished - Feb 2019
Externally publishedYes

Bibliographical note

Funding Information:
National Heart, Lung, and Blood Institute (U.S.), R01HL112815 and K23HL126979.

Publisher Copyright:
© 2018 Elsevier B.V.

Keywords

  • Cardiac arrest
  • Heart arrest
  • PaCO
  • Partial pressure of arterial carbon dioxide

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