Oxygen Targets in Comatose Survivors of Cardiac Arrest
Research output: Contribution to journal › Journal article › Research › peer-review
Standard
Oxygen Targets in Comatose Survivors of Cardiac Arrest. / Schmidt, Henrik; Kjaergaard, Jesper; Hassager, Christian; Mølstrøm, Simon; Grand, Johannes; Borregaard, Britt; Obling, Laust E.Roelsgaard; Venø, Søren; Sarkisian, Laura; Mamaev, Dmitry; Jensen, Lisette O.; Nyholm, Benjamin; Høfsten, Dan E.; Josiassen, Jakob; Thomsen, Jakob H.; Thune, Jens J.; Lindholm, Matias G.; Meyer, Martin A.Stengaard; Winther-Jensen, Matilde; Sørensen, Marc; Frydland, Martin; Beske, Rasmus P.; Frikke-Schmidt, Ruth; Wiberg, Sebastian; Boesgaard, Søren; Jørgensen, Vibeke Lind; Møller, Jacob E.
In: New England Journal of Medicine, Vol. 387, No. 16, 2022, p. 1467-1476.Research output: Contribution to journal › Journal article › Research › peer-review
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Oxygen Targets in Comatose Survivors of Cardiac Arrest
AU - Schmidt, Henrik
AU - Kjaergaard, Jesper
AU - Hassager, Christian
AU - Mølstrøm, Simon
AU - Grand, Johannes
AU - Borregaard, Britt
AU - Obling, Laust E.Roelsgaard
AU - Venø, Søren
AU - Sarkisian, Laura
AU - Mamaev, Dmitry
AU - Jensen, Lisette O.
AU - Nyholm, Benjamin
AU - Høfsten, Dan E.
AU - Josiassen, Jakob
AU - Thomsen, Jakob H.
AU - Thune, Jens J.
AU - Lindholm, Matias G.
AU - Meyer, Martin A.Stengaard
AU - Winther-Jensen, Matilde
AU - Sørensen, Marc
AU - Frydland, Martin
AU - Beske, Rasmus P.
AU - Frikke-Schmidt, Ruth
AU - Wiberg, Sebastian
AU - Boesgaard, Søren
AU - Jørgensen, Vibeke Lind
AU - Møller, Jacob E.
N1 - Publisher Copyright: Copyright © 2022 Massachusetts Medical Society.
PY - 2022
Y1 - 2022
N2 - BACKGROUND The appropriate oxygenation target for mechanical ventilation in comatose survivors of out-of-hospital cardiac arrest is unknown. METHODS In this randomized trial with a 2-by-2 factorial design, we randomly assigned comatose adults with out-of-hospital cardiac arrest in a 1:1 ratio to either a restrictive oxygen target of a partial pressure of arterial oxygen (Pao2) of 9 to 10 kPa (68 to 75 mm Hg) or a liberal oxygen target of a Pao2 of 13 to 14 kPa (98 to 105 mm Hg); patients were also assigned to one of two blood-pressure targets (reported separately). The primary outcome was a composite of death from any cause or hospital discharge with severe disability or coma (Cerebral Performance Category [CPC] of 3 or 4; categories range from 1 to 5, with higher values indicating more severe disability), whichever occurred first within 90 days after randomization. Secondary outcomes were neuron-specific enolase levels at 48 hours, death from any cause, the score on the Montreal Cognitive Assessment (ranging from 0 to 30, with higher scores indicating better cognitive ability), the score on the modified Rankin scale (ranging from 0 to 6, with higher scores indicating greater disability), and the CPC at 90 days. RESULTS A total of 789 patients underwent randomization. A primary-outcome event occurred in 126 of 394 patients (32.0%) in the restrictive-target group and in 134 of 395 patients (33.9%) in the liberal-target group (hazard ratio, 0.95; 95% confidence interval, 0.75 to 1.21; P = 0.69). At 90 days, death had occurred in 113 patients (28.7%) in the restrictive-target group and in 123 (31.1%) in the liberal-target group. On the CPC, the median category was 1 in the two groups; on the modified Rankin scale, the median score was 2 in the restrictive-target group and 1 in the liberaltarget group; and on the Montreal Cognitive Assessment, the median score was 27 in the two groups. At 48 hours, the median neuron-specific enolase level was 17 μg per liter in the restrictive-target group and 18 μg per liter in the liberaltarget group. The incidence of adverse events was similar in the two groups. CONCLUSIONS Targeting of a restrictive or liberal oxygenation strategy in comatose patients after resuscitation for cardiac arrest resulted in a similar incidence of death or severe disability or coma.
AB - BACKGROUND The appropriate oxygenation target for mechanical ventilation in comatose survivors of out-of-hospital cardiac arrest is unknown. METHODS In this randomized trial with a 2-by-2 factorial design, we randomly assigned comatose adults with out-of-hospital cardiac arrest in a 1:1 ratio to either a restrictive oxygen target of a partial pressure of arterial oxygen (Pao2) of 9 to 10 kPa (68 to 75 mm Hg) or a liberal oxygen target of a Pao2 of 13 to 14 kPa (98 to 105 mm Hg); patients were also assigned to one of two blood-pressure targets (reported separately). The primary outcome was a composite of death from any cause or hospital discharge with severe disability or coma (Cerebral Performance Category [CPC] of 3 or 4; categories range from 1 to 5, with higher values indicating more severe disability), whichever occurred first within 90 days after randomization. Secondary outcomes were neuron-specific enolase levels at 48 hours, death from any cause, the score on the Montreal Cognitive Assessment (ranging from 0 to 30, with higher scores indicating better cognitive ability), the score on the modified Rankin scale (ranging from 0 to 6, with higher scores indicating greater disability), and the CPC at 90 days. RESULTS A total of 789 patients underwent randomization. A primary-outcome event occurred in 126 of 394 patients (32.0%) in the restrictive-target group and in 134 of 395 patients (33.9%) in the liberal-target group (hazard ratio, 0.95; 95% confidence interval, 0.75 to 1.21; P = 0.69). At 90 days, death had occurred in 113 patients (28.7%) in the restrictive-target group and in 123 (31.1%) in the liberal-target group. On the CPC, the median category was 1 in the two groups; on the modified Rankin scale, the median score was 2 in the restrictive-target group and 1 in the liberaltarget group; and on the Montreal Cognitive Assessment, the median score was 27 in the two groups. At 48 hours, the median neuron-specific enolase level was 17 μg per liter in the restrictive-target group and 18 μg per liter in the liberaltarget group. The incidence of adverse events was similar in the two groups. CONCLUSIONS Targeting of a restrictive or liberal oxygenation strategy in comatose patients after resuscitation for cardiac arrest resulted in a similar incidence of death or severe disability or coma.
U2 - 10.1056/NEJMoa2208686
DO - 10.1056/NEJMoa2208686
M3 - Journal article
C2 - 36027567
AN - SCOPUS:85140415254
VL - 387
SP - 1467
EP - 1476
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
IS - 16
ER -
ID: 331392199