Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

Abstract Background High levels of arterial oxygen pressures (PaO2) have been associated with increased mortality in extracorporeal cardiopulmonary resuscitation (ECPR), but there is limited information regarding possible mechanisms linking hyperoxia and death in this setting, notably with respect t...

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Autores principales: Jean Bonnemain, Marco Rusca, Zied Ltaief, Aurélien Roumy, Piergiorgio Tozzi, Mauro Oddo, Matthias Kirsch, Lucas Liaudet
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Publicado: BMC 2021
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spelling oai:doaj.org-article:4d31781b342640028c7bc13c8affde192021-11-21T12:04:01ZHyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality10.1186/s12872-021-02361-31471-2261https://doaj.org/article/4d31781b342640028c7bc13c8affde192021-11-01T00:00:00Zhttps://doi.org/10.1186/s12872-021-02361-3https://doaj.org/toc/1471-2261Abstract Background High levels of arterial oxygen pressures (PaO2) have been associated with increased mortality in extracorporeal cardiopulmonary resuscitation (ECPR), but there is limited information regarding possible mechanisms linking hyperoxia and death in this setting, notably with respect to its hemodynamic consequences. We aimed therefore at evaluating a possible association between PaO2, circulatory failure and death during ECPR. Methods We retrospectively analyzed 44 consecutive cardiac arrest (CA) patients treated with ECPR to determine the association between the mean PaO2 over the first 24 h, arterial blood pressure, vasopressor and intravenous fluid therapies, mortality, and cause of deaths. Results Eleven patients (25%) survived to hospital discharge. The main causes of death were refractory circulatory shock (46%) and neurological damage (24%). Compared to survivors, non survivors had significantly higher mean 24 h PaO2 (306 ± 121 mmHg vs 164 ± 53 mmHg, p < 0.001), lower mean blood pressure and higher requirements in vasopressors and fluids, but displayed similar pulse pressure during the first 24 h (an index of native cardiac recovery). The mean 24 h PaO2 was significantly and positively correlated with the severity of hypotension and the intensity of vasoactive therapies. Patients dying from circulatory failure died after a median of 17 h, compared to a median of 58 h for patients dying from a neurological cause. Patients dying from neurological cause had better preserved blood pressure and lower vasopressor requirements. Conclusion In conclusion, hyperoxia is associated with increased mortality during ECPR, possibly by promoting circulatory collapse or delayed neurological damage.Jean BonnemainMarco RuscaZied LtaiefAurélien RoumyPiergiorgio TozziMauro OddoMatthias KirschLucas LiaudetBMCarticleExtracorporeal cardiopulmonary resuscitation (ECPR)Veno-arterial membrane oxygenation (VA-ECMO)Cardiac arrestHyperoxiaDiseases of the circulatory (Cardiovascular) systemRC666-701ENBMC Cardiovascular Disorders, Vol 21, Iss 1, Pp 1-10 (2021)
institution DOAJ
collection DOAJ
language EN
topic Extracorporeal cardiopulmonary resuscitation (ECPR)
Veno-arterial membrane oxygenation (VA-ECMO)
Cardiac arrest
Hyperoxia
Diseases of the circulatory (Cardiovascular) system
RC666-701
spellingShingle Extracorporeal cardiopulmonary resuscitation (ECPR)
Veno-arterial membrane oxygenation (VA-ECMO)
Cardiac arrest
Hyperoxia
Diseases of the circulatory (Cardiovascular) system
RC666-701
Jean Bonnemain
Marco Rusca
Zied Ltaief
Aurélien Roumy
Piergiorgio Tozzi
Mauro Oddo
Matthias Kirsch
Lucas Liaudet
Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality
description Abstract Background High levels of arterial oxygen pressures (PaO2) have been associated with increased mortality in extracorporeal cardiopulmonary resuscitation (ECPR), but there is limited information regarding possible mechanisms linking hyperoxia and death in this setting, notably with respect to its hemodynamic consequences. We aimed therefore at evaluating a possible association between PaO2, circulatory failure and death during ECPR. Methods We retrospectively analyzed 44 consecutive cardiac arrest (CA) patients treated with ECPR to determine the association between the mean PaO2 over the first 24 h, arterial blood pressure, vasopressor and intravenous fluid therapies, mortality, and cause of deaths. Results Eleven patients (25%) survived to hospital discharge. The main causes of death were refractory circulatory shock (46%) and neurological damage (24%). Compared to survivors, non survivors had significantly higher mean 24 h PaO2 (306 ± 121 mmHg vs 164 ± 53 mmHg, p < 0.001), lower mean blood pressure and higher requirements in vasopressors and fluids, but displayed similar pulse pressure during the first 24 h (an index of native cardiac recovery). The mean 24 h PaO2 was significantly and positively correlated with the severity of hypotension and the intensity of vasoactive therapies. Patients dying from circulatory failure died after a median of 17 h, compared to a median of 58 h for patients dying from a neurological cause. Patients dying from neurological cause had better preserved blood pressure and lower vasopressor requirements. Conclusion In conclusion, hyperoxia is associated with increased mortality during ECPR, possibly by promoting circulatory collapse or delayed neurological damage.
format article
author Jean Bonnemain
Marco Rusca
Zied Ltaief
Aurélien Roumy
Piergiorgio Tozzi
Mauro Oddo
Matthias Kirsch
Lucas Liaudet
author_facet Jean Bonnemain
Marco Rusca
Zied Ltaief
Aurélien Roumy
Piergiorgio Tozzi
Mauro Oddo
Matthias Kirsch
Lucas Liaudet
author_sort Jean Bonnemain
title Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality
title_short Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality
title_full Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality
title_fullStr Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality
title_full_unstemmed Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality
title_sort hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality
publisher BMC
publishDate 2021
url https://doaj.org/article/4d31781b342640028c7bc13c8affde19
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