Association of Pediatric Postcardiac Arrest Ventilation and Oxygenation with Survival Outcomes

Aisha H. Frazier; Alexis A. Topjian; Ron W. Reeder; Ryan W. Morgan; Ericka L. Fink; Deborah Franzon; Kathryn Graham; Monica L. Harding; Peter M. Mourani; Vinay M. Nadkarni; Heather A. Wolfe; Tageldin Ahmed; Michael J. Bell; Candice Burns; Joseph A. Carcillo; Todd C. Carpenter; J. Wesley Diddle; Myke Federman; Stuart H. Friess; Mark Hall; David A. Hehir; Christopher M. Horvat; Leanna L. Huard; Tensing Maa; Kathleen L. Meert; Maryam Y. Naim; Daniel Notterman; Murray M. Pollack; Carleen Schneiter; Matthew P. Sharron; Neeraj Srivastava; Shirley Viteri; David Wessel; Andrew R. Yates; Robert M. Sutton; Robert A. Berg

doi:10.1513/AnnalsATS.202311-948OC

Association of Pediatric Postcardiac Arrest Ventilation and Oxygenation with Survival Outcomes

Aisha H. Frazier, Alexis A. Topjian, Ron W. Reeder, Ryan W. Morgan, Ericka L. Fink, Deborah Franzon, Kathryn Graham, Monica L. Harding, Peter M. Mourani, Vinay M. Nadkarni, Heather A. Wolfe, Tageldin Ahmed, Michael J. Bell, Candice Burns, Joseph A. Carcillo, Todd C. Carpenter, J. Wesley Diddle, Myke Federman, Stuart H. Friess, Mark HallDavid A. Hehir, Christopher M. Horvat, Leanna L. Huard, Tensing Maa, Kathleen L. Meert, Maryam Y. Naim, Daniel Notterman, Murray M. Pollack, Carleen Schneiter, Matthew P. Sharron, Neeraj Srivastava, Shirley Viteri, David Wessel, Andrew R. Yates, Robert M. Sutton, Robert A. Berg

Molecular Biology

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Rationale: Adult and pediatric studies provide conflicting data regarding whether post–cardiac arrest hypoxemia, hyperoxemia, hypercapnia, and/or hypocapnia are associated with worse outcomes. Objectives: We sought to determine whether postarrest hypoxemia or postarrest hyperoxemia is associated with lower rates of survival to hospital discharge, compared with postarrest normoxemia, and whether postarrest hypocapnia or hypercapnia is associated with lower rates of survival, compared with postarrest normocapnia. Methods: An embedded prospective observational study during a multicenter interventional cardiopulmonary resuscitation trial was conducted from 2016 to 2021. Patients <18 years old and with a corrected gestational age of >37 weeks who received chest compressions for cardiac arrest in one of the 18 intensive care units were included. Exposures during the first 24 hours postarrest were hypoxemia, hyperoxemia, or normoxemia—defined as lowest arterial oxygen tension/pressure (Pa_O2),60 mm Hg, highest Pa_O2 >200 mm Hg, or every Pa_O2 60–199 mm Hg, respectively—and hypocapnia, hypercapnia, or normocapnia, defined as lowest arterial carbon dioxide tension/pressure (Pa_CO2),30 mm Hg, highest Pa_CO2 >50 mm Hg, or every Pa_CO2 30–49 mm Hg, respectively. Associations of oxygenation and carbon dioxide group with survival to hospital discharge were assessed using Poisson regression with robust error estimates. Results: The hypoxemia group was less likely to survive to hospital discharge, compared with the normoxemia group (adjusted relative risk [aRR] = 0.71; 95% confidence interval [CI] = 0.58–0.87), whereas survival in the hyperoxemia group did not differ from that in the normoxemia group (aRR = 1.0; 95% CI = 0.87–1.15). The hypercapnia group was less likely to survive to hospital discharge, compared with the normocapnia group (aRR = 0.74; 95% CI = 0.64–0.84), whereas survival in the hypocapnia group did not differ from that in the normocapnia group (aRR = 0.91; 95% CI = 0.74–1.12). Conclusions: Postarrest hypoxemia and hypercapnia were each associated with lower rates of survival to hospital discharge.

Original language	English (US)
Pages (from-to)	895-906
Number of pages	12
Journal	Annals of the American Thoracic Society
Volume	21
Issue number	6
DOIs	https://doi.org/10.1513/AnnalsATS.202311-948OC
State	Published - Jun 2024

All Science Journal Classification (ASJC) codes

Pulmonary and Respiratory Medicine

Keywords

child
hypercapnia
hyperoxia
hypocapnia
Hypoxia

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10.1513/AnnalsATS.202311-948OC

Cite this

Frazier, A. H., Topjian, A. A., Reeder, R. W., Morgan, R. W., Fink, E. L., Franzon, D., Graham, K., Harding, M. L., Mourani, P. M., Nadkarni, V. M., Wolfe, H. A., Ahmed, T., Bell, M. J., Burns, C., Carcillo, J. A., Carpenter, T. C., Diddle, J. W., Federman, M., Friess, S. H., ... Berg, R. A. (2024). Association of Pediatric Postcardiac Arrest Ventilation and Oxygenation with Survival Outcomes. Annals of the American Thoracic Society, 21(6), 895-906. https://doi.org/10.1513/AnnalsATS.202311-948OC

@article{d53ba5ace7ed4ac6823254fc524644c0,

title = "Association of Pediatric Postcardiac Arrest Ventilation and Oxygenation with Survival Outcomes",

abstract = "Rationale: Adult and pediatric studies provide conflicting data regarding whether post–cardiac arrest hypoxemia, hyperoxemia, hypercapnia, and/or hypocapnia are associated with worse outcomes. Objectives: We sought to determine whether postarrest hypoxemia or postarrest hyperoxemia is associated with lower rates of survival to hospital discharge, compared with postarrest normoxemia, and whether postarrest hypocapnia or hypercapnia is associated with lower rates of survival, compared with postarrest normocapnia. Methods: An embedded prospective observational study during a multicenter interventional cardiopulmonary resuscitation trial was conducted from 2016 to 2021. Patients <18 years old and with a corrected gestational age of >37 weeks who received chest compressions for cardiac arrest in one of the 18 intensive care units were included. Exposures during the first 24 hours postarrest were hypoxemia, hyperoxemia, or normoxemia—defined as lowest arterial oxygen tension/pressure (PaO2),60 mm Hg, highest PaO2 >200 mm Hg, or every PaO2 60–199 mm Hg, respectively—and hypocapnia, hypercapnia, or normocapnia, defined as lowest arterial carbon dioxide tension/pressure (PaCO2),30 mm Hg, highest PaCO2 >50 mm Hg, or every PaCO2 30–49 mm Hg, respectively. Associations of oxygenation and carbon dioxide group with survival to hospital discharge were assessed using Poisson regression with robust error estimates. Results: The hypoxemia group was less likely to survive to hospital discharge, compared with the normoxemia group (adjusted relative risk [aRR] = 0.71; 95% confidence interval [CI] = 0.58–0.87), whereas survival in the hyperoxemia group did not differ from that in the normoxemia group (aRR = 1.0; 95% CI = 0.87–1.15). The hypercapnia group was less likely to survive to hospital discharge, compared with the normocapnia group (aRR = 0.74; 95% CI = 0.64–0.84), whereas survival in the hypocapnia group did not differ from that in the normocapnia group (aRR = 0.91; 95% CI = 0.74–1.12). Conclusions: Postarrest hypoxemia and hypercapnia were each associated with lower rates of survival to hospital discharge.",

keywords = "child, hypercapnia, hyperoxia, hypocapnia, Hypoxia",

author = "Frazier, {Aisha H.} and Topjian, {Alexis A.} and Reeder, {Ron W.} and Morgan, {Ryan W.} and Fink, {Ericka L.} and Deborah Franzon and Kathryn Graham and Harding, {Monica L.} and Mourani, {Peter M.} and Nadkarni, {Vinay M.} and Wolfe, {Heather A.} and Tageldin Ahmed and Bell, {Michael J.} and Candice Burns and Carcillo, {Joseph A.} and Carpenter, {Todd C.} and Diddle, {J. Wesley} and Myke Federman and Friess, {Stuart H.} and Mark Hall and Hehir, {David A.} and Horvat, {Christopher M.} and Huard, {Leanna L.} and Tensing Maa and Meert, {Kathleen L.} and Naim, {Maryam Y.} and Daniel Notterman and Pollack, {Murray M.} and Carleen Schneiter and Sharron, {Matthew P.} and Neeraj Srivastava and Shirley Viteri and David Wessel and Yates, {Andrew R.} and Sutton, {Robert M.} and Berg, {Robert A.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2024 by the American Thoracic Society.",

year = "2024",

month = jun,

doi = "10.1513/AnnalsATS.202311-948OC",

language = "English (US)",

volume = "21",

pages = "895--906",

journal = "Annals of the American Thoracic Society",

issn = "2325-6621",

publisher = "American Thoracic Society",

number = "6",

}

Frazier, AH, Topjian, AA, Reeder, RW, Morgan, RW, Fink, EL, Franzon, D, Graham, K, Harding, ML, Mourani, PM, Nadkarni, VM, Wolfe, HA, Ahmed, T, Bell, MJ, Burns, C, Carcillo, JA, Carpenter, TC, Diddle, JW, Federman, M, Friess, SH, Hall, M, Hehir, DA, Horvat, CM, Huard, LL, Maa, T, Meert, KL, Naim, MY, Notterman, D, Pollack, MM, Schneiter, C, Sharron, MP, Srivastava, N, Viteri, S, Wessel, D, Yates, AR, Sutton, RM & Berg, RA 2024, 'Association of Pediatric Postcardiac Arrest Ventilation and Oxygenation with Survival Outcomes', Annals of the American Thoracic Society, vol. 21, no. 6, pp. 895-906. https://doi.org/10.1513/AnnalsATS.202311-948OC

TY - JOUR

T1 - Association of Pediatric Postcardiac Arrest Ventilation and Oxygenation with Survival Outcomes

AU - Frazier, Aisha H.

AU - Topjian, Alexis A.

AU - Reeder, Ron W.

AU - Morgan, Ryan W.

AU - Fink, Ericka L.

AU - Franzon, Deborah

AU - Graham, Kathryn

AU - Harding, Monica L.

AU - Mourani, Peter M.

AU - Nadkarni, Vinay M.

AU - Wolfe, Heather A.

AU - Ahmed, Tageldin

AU - Bell, Michael J.

AU - Burns, Candice

AU - Carcillo, Joseph A.

AU - Carpenter, Todd C.

AU - Diddle, J. Wesley

AU - Federman, Myke

AU - Friess, Stuart H.

AU - Hall, Mark

AU - Hehir, David A.

AU - Horvat, Christopher M.

AU - Huard, Leanna L.

AU - Maa, Tensing

AU - Meert, Kathleen L.

AU - Naim, Maryam Y.

AU - Notterman, Daniel

AU - Pollack, Murray M.

AU - Schneiter, Carleen

AU - Sharron, Matthew P.

AU - Srivastava, Neeraj

AU - Viteri, Shirley

AU - Wessel, David

AU - Yates, Andrew R.

AU - Sutton, Robert M.

AU - Berg, Robert A.

PY - 2024/6

Y1 - 2024/6

N2 - Rationale: Adult and pediatric studies provide conflicting data regarding whether post–cardiac arrest hypoxemia, hyperoxemia, hypercapnia, and/or hypocapnia are associated with worse outcomes. Objectives: We sought to determine whether postarrest hypoxemia or postarrest hyperoxemia is associated with lower rates of survival to hospital discharge, compared with postarrest normoxemia, and whether postarrest hypocapnia or hypercapnia is associated with lower rates of survival, compared with postarrest normocapnia. Methods: An embedded prospective observational study during a multicenter interventional cardiopulmonary resuscitation trial was conducted from 2016 to 2021. Patients <18 years old and with a corrected gestational age of >37 weeks who received chest compressions for cardiac arrest in one of the 18 intensive care units were included. Exposures during the first 24 hours postarrest were hypoxemia, hyperoxemia, or normoxemia—defined as lowest arterial oxygen tension/pressure (PaO2),60 mm Hg, highest PaO2 >200 mm Hg, or every PaO2 60–199 mm Hg, respectively—and hypocapnia, hypercapnia, or normocapnia, defined as lowest arterial carbon dioxide tension/pressure (PaCO2),30 mm Hg, highest PaCO2 >50 mm Hg, or every PaCO2 30–49 mm Hg, respectively. Associations of oxygenation and carbon dioxide group with survival to hospital discharge were assessed using Poisson regression with robust error estimates. Results: The hypoxemia group was less likely to survive to hospital discharge, compared with the normoxemia group (adjusted relative risk [aRR] = 0.71; 95% confidence interval [CI] = 0.58–0.87), whereas survival in the hyperoxemia group did not differ from that in the normoxemia group (aRR = 1.0; 95% CI = 0.87–1.15). The hypercapnia group was less likely to survive to hospital discharge, compared with the normocapnia group (aRR = 0.74; 95% CI = 0.64–0.84), whereas survival in the hypocapnia group did not differ from that in the normocapnia group (aRR = 0.91; 95% CI = 0.74–1.12). Conclusions: Postarrest hypoxemia and hypercapnia were each associated with lower rates of survival to hospital discharge.

AB - Rationale: Adult and pediatric studies provide conflicting data regarding whether post–cardiac arrest hypoxemia, hyperoxemia, hypercapnia, and/or hypocapnia are associated with worse outcomes. Objectives: We sought to determine whether postarrest hypoxemia or postarrest hyperoxemia is associated with lower rates of survival to hospital discharge, compared with postarrest normoxemia, and whether postarrest hypocapnia or hypercapnia is associated with lower rates of survival, compared with postarrest normocapnia. Methods: An embedded prospective observational study during a multicenter interventional cardiopulmonary resuscitation trial was conducted from 2016 to 2021. Patients <18 years old and with a corrected gestational age of >37 weeks who received chest compressions for cardiac arrest in one of the 18 intensive care units were included. Exposures during the first 24 hours postarrest were hypoxemia, hyperoxemia, or normoxemia—defined as lowest arterial oxygen tension/pressure (PaO2),60 mm Hg, highest PaO2 >200 mm Hg, or every PaO2 60–199 mm Hg, respectively—and hypocapnia, hypercapnia, or normocapnia, defined as lowest arterial carbon dioxide tension/pressure (PaCO2),30 mm Hg, highest PaCO2 >50 mm Hg, or every PaCO2 30–49 mm Hg, respectively. Associations of oxygenation and carbon dioxide group with survival to hospital discharge were assessed using Poisson regression with robust error estimates. Results: The hypoxemia group was less likely to survive to hospital discharge, compared with the normoxemia group (adjusted relative risk [aRR] = 0.71; 95% confidence interval [CI] = 0.58–0.87), whereas survival in the hyperoxemia group did not differ from that in the normoxemia group (aRR = 1.0; 95% CI = 0.87–1.15). The hypercapnia group was less likely to survive to hospital discharge, compared with the normocapnia group (aRR = 0.74; 95% CI = 0.64–0.84), whereas survival in the hypocapnia group did not differ from that in the normocapnia group (aRR = 0.91; 95% CI = 0.74–1.12). Conclusions: Postarrest hypoxemia and hypercapnia were each associated with lower rates of survival to hospital discharge.

KW - child

KW - hypercapnia

KW - hyperoxia

KW - hypocapnia

KW - Hypoxia

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SN - 2325-6621

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JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

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Association of Pediatric Postcardiac Arrest Ventilation and Oxygenation with Survival Outcomes

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