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Title: Conservative or liberal oxygen therapy in adults after cardiac arrest: An individual-level patient data meta-analysis of randomised controlled trials.
Austin Authors: Young, Paul J;Bailey, Michael;Bellomo, Rinaldo ;Bernard, Stephen;Bray, Janet;Jakkula, Pekka;Kuisma, Markku;Mackle, Diane;Martin, Daniel;Nolan, Jerry P;Panwar, Rakshit;Reinikainen, Matti;Skrifvars, Markus B;Thomas, Matt
Affiliation: Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
Peninsula Medical School, University of Plymouth, UK
Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
University of Melbourne, Parkville, Victoria, Australia
Intensive Care Unit, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
Intensive Care Unit, Royal Free Hospital, London, UK
Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
Consultant in Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
Intensive Care Unit
Department of Perioperative, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Finland
Department of Emergency Medicine, Helsinki University Hospital, Finland
Medical Research Institute of New Zealand, Wellington, New Zealand
Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland
Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Centre for Integrated Critical Care, University of Melbourne, Parkville, Victoria, Australia
Issue Date: Dec-2020
Date: 2020-10-12
Publication information: Resuscitation 2020; 157: 15-22
Abstract: The effect of conservative versus liberal oxygen therapy on mortality rates in post cardiac arrest patients is uncertain. We undertook an individual patient data meta-analysis of patients randomised in clinical trials to conservative or liberal oxygen therapy after a cardiac arrest. The primary end point was mortality at last follow-up. Individual level patient data were obtained from seven randomised clinical trials with a total of 429 trial participants included. Four trials enrolled patients in the pre-hospital period. Of these, two provided protocol-directed oxygen therapy for 60 min, one provided it until the patient was handed over to the emergency department staff, and one provided it for a total of 72 h or until the patient was extubated. Three trials enrolled patients after intensive care unit (ICU) admission and generally continued protocolised oxygen therapy for a longer period, often until ICU discharge. A total of 90 of 221 patients (40.7%) assigned to conservative oxygen therapy and 103 of 206 patients (50%) assigned to liberal oxygen therapy had died by this last point of follow-up; absolute difference; odds ratio (OR) adjusted for study only; 0.67; 95% CI 0.45 to 0.99; P = 0.045; adjusted OR, 0.58; 95% CI 0.35 to 0.96; P = 0.04. Conservative oxygen therapy was associated with a statistically significant reduction in mortality at last follow-up compared to liberal oxygen therapy but the certainty of available evidence was low or very low due to bias, imprecision, and indirectness. CRD42019138931.
DOI: 10.1016/j.resuscitation.2020.09.036
Journal: Resuscitation
PubMed URL: 33058991
Type: Journal Article
Subjects: Cardiac arrest
Hypoxic ischaemic encephalopathy
Individual patient data meta-analysis
Oxygen therapy
Randomised controlled trial
Appears in Collections:Journal articles

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