Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33123
Title: Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest.
Austin Authors: Eastwood, Glenn M ;Nichol, Alistair D;Hodgson, Carol;Parke, Rachael L;McGuinness, Shay;Nielsen, Niklas;Bernard, Stephen;Skrifvars, Markus B;Stub, Dion;Taccone, Fabio S;Archer, John S ;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;Svenšek, Franc;McGuigan, Peter J;Cole, Jade;Pogson, David;Hilty, Matthias P;Düring, Joachim P;Bailey, Michael J;Paul, Eldho;Ady, Bridget;Ainscough, Kate;Hunt, Anna;Monahan, Sinéad;Trapani, Tony;Fahey, Ciara;Bellomo, Rinaldo 
Affiliation: Intensive Care
Neurology
Australian and New Zealand Intensive Care Research Centre
School of Public Health and Preventive Medicine, Monash University
Department of Intensive Care, Alfred Hospital
Department of Cardiology, Alfred Hospital
Division of Critical Care, University of Melbourne
Departments of Medicine and Critical Care, University of Melbourne
Department of Intensive Care, Royal Melbourne Hospital
Department of Intensive Care, Northern Hospital, Melbourne, VIC
Division of Critical Care, George Institute for Global Health, Sydney
Intensive Care Unit, Princess Alexandra Hospital, Australia
School of Medicine, University of Queensland, Brisbane, Australia
Clinical Research Centre at St. Vincent's Hospital, University College Dublin, Dublin
Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, New Zealand
Department of Critical Care Medicine, Auckland City Hospital, New Zealand
School of Nursing, University of Auckland, Auckland, New Zealand
Intensive Care Research, Wellington Regional Hospital, Wellington, New Zealand
Medical Research Institute of New Zealand, Wellington, New Zealand
Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
Department of Intensive Care, Christchurch Hospital, Canterbury, New Zealand
Anesthesiology and Intensive Care, Cardiology, and Neurology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Helsingborg Hospital, Helsingborg, Sweden
Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Helsingborg Hospital, Helsingborg, Sweden
Department of Anesthesia and Intensive Care Medicine, Skåne University Hospital, Malmo, Sweden
Departments of Emergency Care and Services and Intensive Care Helsinki University Hospital and University of Helsinki,
Department of Neurology, Helsinki University Hospital
Department of Intensive Care, Hôpital Universitaire de Bruxelles-Université Libre de Bruxelles, Brussels
Department of Intensive Care, Erasme University Hospital, Brussels
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
Emergency Department and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University
Departments of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Reanimation Medicale, Centre Hospitalier Universitaire, Franche-Comte, Unité de Formation et de Recherche Santé, University of Franche-Comte, Besançon, France
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
School of Medicine, Vita-Salute San Raffaele University, Milan
Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam
Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Medicine, University of Oslo
Department of Cardiology, Oslo University Hospital-Ullevål,Oslo
Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
College of Medicine, King Saud bin Abdulaziz University Hospital for Health Sciences, Riyadh, Saudi Arabia
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
Cardiology Department, Tan Tock Seng Hospital, Singapore
School of Medicine, National University of Singapore Yong Loo Lin School of Medicine, Singapore
Department of Medicine, Nanyang Technological University Lee Kong Chian School of Medicine, Singapore
Department of Internal Intensive Medicine, University Medical Center Maribor, Maribor, Slovenia
Department of Intensive Care Medicine, Bern University Hospital
Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern
Departments of Intensive Care Medicine and Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern
Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich
Department of Adult Critical Care, University Hospital of Wales, Cardiff
Intensive Care Unit, Bristol Royal Infirmary, Bristol
Regional Intensive Care Unit, Royal Victoria Hospital, United Kingdom
Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast
Academic Department of Critical Care, Queen Alexandra Hospital, Portsmouth, United Kingdom
Issue Date: 6-Jul-2023
Date: 2023
Publication information: The New England Journal of Medicine 2023; 389(1)
Abstract: 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. 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 1:1 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. 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. 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.).
URI: https://ahro.austin.org.au/austinjspui/handle/1/33123
DOI: 10.1056/NEJMoa2214552
ORCID: 0000-0001-9002-2075
0000-0002-2765-881X
0000-0003-1538-9824
Journal: The New England Journal of Medicine
PubMed URL: 37318140
ISSN: 1533-4406
Type: Journal Article
Appears in Collections:Journal articles

Show full item record

Page view(s)

58
checked on May 24, 2024

Google ScholarTM

Check


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.