Blog Viewer

Oxygen Targets in Comatose Survivors of Cardiac Arrest

By Currents Editor posted 12-08-2022 12:19

  

New England Journal of Medicine (10/20/22) DOI: 10.1056/NEJMoa2208686

Schmidt, Henrik; Kjaergaard, Jesper; Hassager, Christian; et al.

https://www.nejm.org/doi/full/10.1056/NEJMoa2208686

Following a restrictive or liberal oxygenation strategy for comatose patients after resuscitation for cardiac arrest led to a similar incidence of death or severe disability or coma, according to new research. Comatose patients with out-of-hospital cardiac arrest were randomly assigned 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. Overall, 32% (126 of 394) of the patients in the restrictive-target group and 33.9% (134 of 395) of those in the liberal-target group experienced a primary-outcome event, defined as a composite of death from any cause or hospital discharge with severe disability or coma, whichever occurred first within 90 days of randomization. The mortality rates in the two groups at 90 days were 28.7% (113) and 31.1% (123), respectively. The median category in the two groups for the Cerebral Performance Category was 1, while on the modified Rankin scale, the median score was 2 in the restrictive-target group and 1 in the liberal-target group. The median score in the two groups on the Montreal Cognitive Assessment was 27. Another secondary outcome, the median neuron-specific enolase level at 48 hours, was 17 μg per liter and 18 μg per liter in the two groups, respectively. Infection, bleeding, and seizures were the most common adverse events. No significant between-group differences were reported in any prespecified adverse events, the researchers report.

#LiteratureWatch

FURTHER READING
Michelle Schober, MD, MS Audrey Paulson, DNP, FNP-BC, CCRN, CNRN, SCRN Ethical principles common to the various health care professions include the concepts of justice, nonmaleficence, beneficence, and autonomy. The American Nurses Association (ANA) Code contains these concepts and cites three additional ...
New England Journal of Medicine (10/20/22) DOI: 10.1056/NEJMoa2208687 Kjaergaard, Jesper; Møller, Jacob E.; Schmidt, Henrik; et al. https://www.nejm.org/doi/full/10.1056/NEJMoa2208687 For patients who had been resuscitated from cardiac arrest, targeting a mean arterial blood pressure of 77 mm Hg ...
By Sarah Livesay, DNP, APRN Associate Dean, Rush University, President NCS Mary Kay Bader, RN, MSN, Neurocritical Care CNS, Mission Hospital Mission Viejo CA, Past President NCS Karen Hirsch MD, Associate Professor of Neurology, Division Chief Neurocriticial Care, Stanford University Romer Geocadin ...