Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33748
Title: Cardiovascular changes induced by targeted mild hypercapnia after out of hospital cardiac arrest. A sub-study of the TAME cardiac arrest trial.
Austin Authors: Baumann Melberg, Mathias;Flaa, Arnljot;Øystein Andersen, Geir;Sunde, Kjetil;Bellomo, Rinaldo ;Eastwood, Glenn M ;Mariero Olasveengen, Theresa;Qvigstad, Eirik
Affiliation: Department of Research and Development, Division of Emergencies and Critical Care, Department of Cardiology, Division of Medicine, Oslo University Hospital, Oslo, Norway and Institute of Clinical Medicine, University of Oslo.
Department of Cardiology, Division of Medicine, Oslo University Hospital, Oslo.
Department of Anaesthesiology and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway and Institute of Clinical Medicine, University of Oslo.
Intensive Care
Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Melbourne, Australia.
Department of Anaesthesiology and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway and Institute of Clinical Medicine, University of Oslo.
Department of Cardiology, Division of Medicine, Oslo University Hospital, Oslo, Norway.
Department of Critical Care, Melbourne University, Melbourne, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia.
Issue Date: Dec-2023
Date: 2023
Publication information: Resuscitation 2023-12; 193
Abstract: Hypercapnia may elicit detrimental haemodynamic effects in critically ill patients. We aimed to investigate the consequences of targeted mild hypercapnia versus targeted normocapnia on pulmonary vascular resistance and right ventricular function in patients resuscitated from out-of-hospital cardiac arrest (OHCA). Pre-planned, single-centre, prospective, sub-study of the Targeted Therapeutic Mild Hypercapnia After Resuscitated Cardiac Arrest (TAME) trial. Patients were randomised to mild hypercapnia (PaCO2 = 6.7-7.3 kPa) or normocapnia (PaCO2 = 4.7-6.0 kPa) for 24 hours. Haemodynamic assessment was performed with right heart catheterisation and serial blood-gas analyses every4th hour for 48 hours. We studied 84 patients. Mean pH was 7.24 (95 % CI 7.22-7.30) and 7.32 (95 % CI 7.31-7.34) with hypercapnia and normocapnia, respectively (P-group <0.001). Pulmonary vascular resistance index (PVRI), pulmonary artery pulsatility index, and right atrial pressure did not differ between groups (P-group >0.05). Mean cardiac index was higher with mild hypercapnia (P-group <0.001): 2.0 (95 % CI 1.85-2.1) vs 1.6 (95 % CI 1.52-1.76) L/min/m2. Systemic vascular resistance index was 2579 dyne-sec/cm-5/ m2 (95 % CI 2356-2830) with hypercapnia, and 3249 dyne-sec/cm-5/ m2 (95 % CI 2930 - 3368) with normocapnia (P-group <0.001). Stroke volumes (P-group =0.013) and mixed venous oxygen saturation (P-group <0.001) were higher in the hypercapnic group. In resuscitated OHCA patients, targeting mild hypercapnia did not increase PVRI or worsen right ventricular function compared to normocapnia. Mild hypercapnia comparatively improved cardiac performance and mixed venous oxygen saturation.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33748
DOI: 10.1016/j.resuscitation.2023.109970
ORCID: 
Journal: Resuscitation
Start page: 109970
PubMed URL: 37716401
ISSN: 1873-1570
Type: Journal Article
Subjects: Out-of-hospital cardiac arrest
TAME cardiac arrest trial
post-cardiac arrest care
right heart catheterisation
targeted mild hypercapnia
Appears in Collections:Journal articles

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