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Early Oxygenation and Ventilation Measurements After Pediatric Cardiac Arrest: Lack of Association With Outcome

Bennett, Kimberly Statler MD, MPH1,2; Clark, Amy E. MS2; Meert, Kathleen L. MD3; Topjian, Alexis A. MD, MSCE4; Schleien, Charles L. MD, MBA5; Shaffner, Donald H. MD6; Dean, J. Michael MD, MBA2; Moler, Frank W. MD, MS7for the Pediatric Emergency Care Medicine Applied Research Network

doi: 10.1097/CCM.0b013e318287f54c
Pediatric Critical Care

Objectives: To explore oxygenation and ventilation status early after cardiac arrest in infants and children. We hypothesize that hyperoxia is common and associated with worse outcome after pediatric cardiac arrest.

Design: Retrospective cohort study.

Setting: Fifteen hospitals within the Pediatric Emergency Care Applied Research Network.

Patients: Children who suffered a cardiac arrest event and survived for at least 6 hours after return of circulation.

Interventions: None.

Measurements and Main Results: Analysis of 195 events revealed that abnormalities in oxygenation and ventilation are common during the initial 6 hours after pediatric cardiac arrest. Hyperoxia was frequent, affecting 54% of patients. Normoxia was documented in 34% and hypoxia in 22% of patients. These percentages account for a 10% overlap of patients who had both hyperoxia and hypoxia. Ventilation status was more evenly distributed with hyperventilation observed in 38%, normoventilation in 29%, and hypoventilation in 46%, with a 13% overlap of patients who had both hyperventilation and hypoventilation. Derangements in both oxygenation and ventilation were common early after cardiac arrest such that both normoxia and normocarbia were documented in only 25 patients (13%). Neither oxygenation nor ventilation status was associated with outcome. After controlling for potential confounders, arrest location and rhythm were significantly associated with worse outcome; however, hyperoxia was not (odds ratio for good outcome, 1.02 [0.46, 2.84]; p = 0.96).

Conclusions: Despite recent resuscitation guidelines that advocate maintenance of normoxia and normoventilation after pediatric cardiac arrest, this is uncommonly achieved in practice. Although we did not demonstrate an association between hyperoxia and worse outcome, the small proportion of patients kept within normal ranges limited our power. Preclinical data suggesting potential harm with hyperoxia remain compelling, and further investigation, including prospective, large studies involving robust recording of physiological derangements, is necessary to further advance our understanding of this important topic.

1 Pediatric Critical Care, Primary Children’s Medical Center, Salt Lake City, UT.

2 Department of Pediatrics, University of Utah, Salt Lake City, UT.

3 Pediatric Critical Care, Children’s Hospital of Michigan, Wayne State University, Detroit, MI.

4 Pediatric Critical Care, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.

5 Pediatric Critical Care, Children’s Hospital of New York, Columbia University, New York, NY.

6 Pediatric Critical Care, The Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD.

7 Pediatric Critical Care, CS Mott Children’s Hospital, University of Michigan, Ann Arbor, MI.

Supported, in part, by the federal grants (HD044955 and HD050531) to Dr. Moler; and the Emergency Medical Services for Children (EMSC) program of the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services (U03MC00001, U03MC00003, U03MC00006, U03MC00007, and U03MC00008) to the Pediatric Emergency Care Applied Research Network (PECARN).

Drs. Statler Bennett, Clark, Topjian, Schleien, Shaffner, and Moler receiving funding from the National Institutes of Health. Dr. Meert received funding from the Emergency Medical Services for Children Program of Maternal and Child Health Bureau, U.S. Department of HHS. Dr. Dean received grant and travel support from NIH.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins