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Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest.
Eastwood, Glenn; Nichol, Alistair D; Hodgson, Carol; Parke, Rachael L; McGuinness, Shay; Nielsen, Niklas; Bernard, Stephen; Skrifvars, Markus B; Stub, Dion; Taccone, Fabio S; Archer, John; Kutsogiannis, Demetrios; Dankiewicz, Josef; Lilja, Gisela; Cronberg, Tobias; Kirkegaard, Hans; Capellier, Gilles; Landoni, Giovanni; Horn, Janneke; Olasveengen, Theresa; Arabi, Yaseen; Chia, Yew Woon; Markota, Andrej; Hænggi, Matthias; Wise, Matt P; Grejs, Anders M; Christensen, Steffen; Munk-Andersen, Heidi; Granfeldt, Asger; Andersen, Geir Ø; Qvigstad, Eirik; Flaa, Arnljot; Thomas, Matthew; Sweet, Katie; Bewley, Jeremy; Bäcklund, Minna; Tiainen, Marjaana; Iten, Manuela; Levis, Anja; Peck, Leah; Walsham, James; Deane, Adam; Ghosh, Angajendra; Annoni, Filippo; Chen, Yan; Knight, David; Lesona, Eden; Tlayjeh, Haytham; Svensek, Franc; McGuigan, Peter J.
Afiliación
  • Eastwood G; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Nichol AD; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Hodgson C; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Parke RL; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • McGuinness S; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Nielsen N; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Bernard S; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Skrifvars MB; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Stub D; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Taccone FS; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Archer J; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Kutsogiannis D; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Dankiewicz J; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Lilja G; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Cronberg T; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Kirkegaard H; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Capellier G; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Landoni G; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Horn J; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Olasveengen T; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Arabi Y; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Chia YW; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Markota A; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Hænggi M; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Wise MP; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Grejs AM; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Christensen S; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Munk-Andersen H; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Granfeldt A; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Andersen GØ; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Qvigstad E; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Flaa A; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Thomas M; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Sweet K; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Bewley J; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Bäcklund M; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Tiainen M; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Iten M; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Levis A; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Peck L; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Walsham J; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Deane A; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Ghosh A; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Annoni F; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Chen Y; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Knight D; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Lesona E; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Tlayjeh H; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • Svensek F; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
  • McGuigan PJ; From the Departments of Intensive Care (G.E., L.P., R.B.) and Neurology (J.A.), Austin Hospital, the Australian and New Zealand Intensive Care Research Centre (G.E., A.D.N., C.H., S.M., G.C., M.J.B., E.P., B.A., T.T., R.B.), the School of Public Health and Preventive Medicine, Monash University (S.B
N Engl J Med ; 389(1): 45-57, 2023 Jul 06.
Article en En | MEDLINE | ID: mdl-37318140
ABSTRACT

BACKGROUND:

Guidelines recommend normocapnia for adults with coma who are resuscitated after out-of-hospital cardiac arrest. However, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes.

METHODS:

We randomly assigned adults with coma who had been resuscitated after out-of-hospital cardiac arrest of presumed cardiac or unknown cause and admitted to the intensive care unit (ICU) in a 11 ratio to either 24 hours of mild hypercapnia (target partial pressure of arterial carbon dioxide [Paco2], 50 to 55 mm Hg) or normocapnia (target Paco2, 35 to 45 mm Hg). The primary outcome was a favorable neurologic outcome, defined as a score of 5 (indicating lower moderate disability) or higher, as assessed with the use of the Glasgow Outcome Scale-Extended (range, 1 [death] to 8, with higher scores indicating better neurologic outcome) at 6 months. Secondary outcomes included death within 6 months.

RESULTS:

A total of 1700 patients from 63 ICUs in 17 countries were recruited, with 847 patients assigned to targeted mild hypercapnia and 853 to targeted normocapnia. A favorable neurologic outcome at 6 months occurred in 332 of 764 patients (43.5%) in the mild hypercapnia group and in 350 of 784 (44.6%) in the normocapnia group (relative risk, 0.98; 95% confidence interval [CI], 0.87 to 1.11; P = 0.76). Death within 6 months after randomization occurred in 393 of 816 patients (48.2%) in the mild hypercapnia group and in 382 of 832 (45.9%) in the normocapnia group (relative risk, 1.05; 95% CI, 0.94 to 1.16). The incidence of adverse events did not differ significantly between groups.

CONCLUSIONS:

In patients with coma who were resuscitated after out-of-hospital cardiac arrest, targeted mild hypercapnia did not lead to better neurologic outcomes at 6 months than targeted normocapnia. (Funded by the National Health and Medical Research Council of Australia and others; TAME ClinicalTrials.gov number, NCT03114033.).
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Reanimación Cardiopulmonar / Coma / Paro Cardíaco Extrahospitalario / Hipercapnia Tipo de estudio: Clinical_trials / Etiology_studies / Guideline Límite: Adult / Humans Idioma: En Revista: N Engl J Med Año: 2023 Tipo del documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Reanimación Cardiopulmonar / Coma / Paro Cardíaco Extrahospitalario / Hipercapnia Tipo de estudio: Clinical_trials / Etiology_studies / Guideline Límite: Adult / Humans Idioma: En Revista: N Engl J Med Año: 2023 Tipo del documento: Article