Hyperoxia and the Post-Arrest Patient

• Current post-arrest guideilnes recommend titrating supplemental O2 to avoid hypoxia and limit exposure to hyperoxia.
• Importantly, these recommendations are based primarily on retrospective studies that have used ABG values within the first 24 hours following ROSC.
• The latest study to evaluate the impact of hyperoxia following cardiac arrest was just published in Circulation. 
• This study is a prospective, cohort study that evaluated the association between early hyperoxia and poor neurologic outcome in adults following cardiac arrest. (ABGs were obtained at 1 hour and 6 hours following ROSC)
• Of 280 patients, 38% were exposed to early hyperoxia (defined as a PaO2 > 300 mm Hg)
• Take Home Points
  • Early hyperoxia was found to be an independent predictor of poor neurologic outcome at hospital discharge.
  • One hour longer duration of hyperoxia was associated with a 3% increase in the risk of poor neurologic outcome
  • SaO2 could not reliably exclude the presence of hyperoxia.

References

Roberts BW, et al. Association between early hyperoxia exposure after resuscitation from cardiac arrest and neurological disability: a prospective multi-center protocol-directed cohort study. Circulation 2018; epub ahead of print.