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Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest.

Eastwood G., Nichol AD., Hodgson C., Parke RL., McGuinness S., Nielsen N., Bernard S., Skrifvars MB., Stub D., Taccone FS., Archer J., Kutsogiannis D., Dankiewicz J., Lilja G., Cronberg T., Kirkegaard H., Capellier G., Landoni G., Horn J., Olasveengen T., Arabi Y., Chia YW., Markota A., Hænggi M., Wise MP., Grejs AM., Christensen S., Munk-Andersen H., Granfeldt A., Andersen GØ., Qvigstad E., Flaa A., Thomas M., Sweet K., Bewley J., Bäcklund M., Tiainen M., Iten M., Levis A., Peck L., Walsham J., Deane A., Ghosh A., Annoni F., Chen Y., Knight D., Lesona E., Tlayjeh H., Svenšek F., McGuigan PJ., Cole J., Pogson D., Hilty MP., Düring JP., Bailey MJ., Paul E., Ady B., Ainscough K., Hunt A., Monahan S., Trapani T., Fahey C., Bellomo R., TAME Study Investigators .

BackgroundGuidelines recommend normocapnia for adults with coma who are resuscitated after out-of-hospital cardiac arrest. However, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes.MethodsWe randomly assigned adults with coma who had been resuscitated after out-of-hospital cardiac arrest of presumed cardiac or unknown cause and admitted to the intensive care unit (ICU) in a 1:1 ratio to either 24 hours of mild hypercapnia (target partial pressure of arterial carbon dioxide [Paco2], 50 to 55 mm Hg) or normocapnia (target Paco2, 35 to 45 mm Hg). The primary outcome was a favorable neurologic outcome, defined as a score of 5 (indicating lower moderate disability) or higher, as assessed with the use of the Glasgow Outcome Scale-Extended (range, 1 [death] to 8, with higher scores indicating better neurologic outcome) at 6 months. Secondary outcomes included death within 6 months.ResultsA total of 1700 patients from 63 ICUs in 17 countries were recruited, with 847 patients assigned to targeted mild hypercapnia and 853 to targeted normocapnia. A favorable neurologic outcome at 6 months occurred in 332 of 764 patients (43.5%) in the mild hypercapnia group and in 350 of 784 (44.6%) in the normocapnia group (relative risk, 0.98; 95% confidence interval [CI], 0.87 to 1.11; P = 0.76). Death within 6 months after randomization occurred in 393 of 816 patients (48.2%) in the mild hypercapnia group and in 382 of 832 (45.9%) in the normocapnia group (relative risk, 1.05; 95% CI, 0.94 to 1.16). The incidence of adverse events did not differ significantly between groups.ConclusionsIn patients with coma who were resuscitated after out-of-hospital cardiac arrest, targeted mild hypercapnia did not lead to better neurologic outcomes at 6 months than targeted normocapnia. (Funded by the National Health and Medical Research Council of Australia and others; TAME ClinicalTrials.gov number, NCT03114033.).

More information Original publication

DOI

10.1056/nejmoa2214552

Type

Journal article

Publication Date

2023-07-01T00:00:00+00:00

Volume

389

Pages

45 - 57

Total pages

12

Addresses

F, r, o, m, , t, h, e, , D, e, p, a, r, t, m, e, n, t, s, , o, f, , I, n, t, e, n, s, i, v, e, , C, a, r, e, , (, G, ., E, ., ,, , L, ., P, ., ,, , R, ., B, ., ), , a, n, d, , N, e, u, r, o, l, o, g, y, , (, J, ., A, ., ), ,, , A, u, s, t, i, n, , H, o, s, p, i, t, a, l, ,, , t, h, e, , A, u, s, t, r, a, l, i, a, n, , a, n, d, , N, e, w, , Z, e, a, l, a, n, d, , I, n, t, e, n, s, i, v, e, , C, a, r, e, , R, e, s, e, a, r, c, h, , C, e, n, t, r, e, , (, G, ., E, ., ,, , A, ., D, ., N, ., ,, , C, ., H, ., ,, , S, ., M, ., ,, , G, ., C, ., ,, , M, ., J, ., B, ., ,, , E, ., P, ., ,, , B, ., A, ., ,, , T, ., T, ., ,, , R, ., B, ., ), ,, , t, h, e, , S, c, h, o, o, l, , o, f, , P, u, b, l, i, c, , H, e, a, l, t, h, , a, n, d, , P, r, e, v, e, n, t, i, v, e, , M, e, d, i, c, i, n, e, ,, , M, o, n, a, s, h, , U, n, i, v, e, r, s, i, t, y, , (, S, ., B, ., ,, , D, ., S, ., ), ,, , t, h, e, , D, e, p, a, r, t, m, e, n, t, s, , o, f, , I, n, t, e, n, s, i, v, e, , C, a, r, e, , (, C, ., H, ., ,, 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p, a, r, t, m, e, n, t, , o, f, , I, n, t, e, n, s, i, v, e, , C, a, r, e, ,, , A, m, s, t, e, r, d, a, m, , U, n, i, v, e, r, s, i, t, y, , M, e, d, i, c, a, l, , C, e, n, t, e, r, s, ,, , A, m, s, t, e, r, d, a, m, , (, J, ., H, ., ), ;, , t, h, e, , D, e, p, a, r, t, m, e, n, t, , o, f, , A, n, e, s, t, h, e, s, i, o, l, o, g, y, , a, n, d, , I, n, t, e, n, s, i, v, e, , C, a, r, e, , M, e, d, i, c, i, n, e, ,, , I, n, s, t, i, t, u, t, e, , o, f, , C, l, i, n, i, c, a, l, , M, e, d, i, c, i, n, e, ,, , U, n, i, v, e, r, s, i, t, y, , o, f, , O, s, l, o, , (, T, ., O, ., ), ,, , a, n, d, , t, h, e, , D, e, p, a, r, t, m, e, n, t, , o, f, , C, a, r, d, i, o, l, o, g, y, ,, , O, s, l, o, , U, n, i, v, e, r, s, i, t, y, , H, o, s, p, i, t, a, l, -, U, l, l, e, v, å, l, , (, G, ., Ø, ., A, ., ,, , E, ., Q, ., ,, , A, ., F, ., ), , -, , b, o, t, h, , i, n, , O, s, l, o, ;, , t, h, e, , I, n, t, e, n, s, i, v, e, , C, a, r, e, , D, e, p, a, r, t, m, e, n, t, ,, , M, i, n, i, s, t, r, y, , o, f, , N, a, t, i, o, n, a, l, , G, u, a, r, d, , H, e, a, l, t, h, , A, f, f, a, i, r, s, ,, , t, h, e, , C, o, l, l, e, g, e, , o, f, , M, e, d, i, c, i, n, e, ,, , K, i, n, g, , S, a, u, d, , b, i, n, , A, b, d, u, l, a, z, i, z, , U, n, i, v, e, r, s, i, t, y, , H, o, s, p, i, t, a, l, , f, o, r, , H, e, a, l, t, h, , S, c, i, e, n, c, e, s, ,, , a, n, d, , K, i, n, g, , A, b, d, u, l, l, a, h, , I, n, t, e, r, n, a, t, i, o, n, a, l, , M, e, d, i, c, a, l, , R, e, s, e, a, r, c, h, , C, e, n, t, e, r, , -, , a, l, l, , i, n, , R, i, y, a, d, h, ,, , S, a, u, d, i, , A, r, a, b, i, a, , (, Y, ., A, ., ,, , H, ., T, ., ), ;, , t, h, e, , C, a, r, d, i, o, l, o, g, y, , D, e, p, a, r, t, m, e, n, t, ,, , T, a, n, , T, o, c, k, , S, e, n, g, , H, o, s, p, i, t, a, l, ,, , t, h, e, , S, c, h, o, o, l, , o, f, , M, e, d, i, c, i, n, e, ,, , N, a, t, i, o, n, a, l, , U, n, i, v, e, r, s, i, t, y, , o, f, , S, i, n, g, a, p, o, r, e, , Y, o, n, g, , L, o, o, , L, i, n, , S, c, h, o, o, l, , o, f, , M, e, d, i, c, i, n, e, ,, , a, n, d, , t, h, e, , D, e, p, a, r, t, m, e, n, t, , o, f, , M, e, d, i, c, i, n, e, ,, , N, a, n, y, a, n, g, , T, e, c, h, n, o, l, o, g, i, c, a, l, , U, n, i, v, e, r, s, i, t, y, , L, e, e, , K, o, n, g, , C, h, i, a, n, , S, c, h, o, o, l, , o, f, , M, e, d, i, c, i, n, e, , -, , a, l, l, , i, n, , S, i, n, g, a, p, o, r, e, , (, Y, ., W, ., C, ., ), ;, , t, h, e

Keywords

TAME Study Investigators, Humans, Coma, Hypercapnia, Carbon Dioxide, Cardiopulmonary Resuscitation, Critical Care, Hospitalization, Adult, Out-of-Hospital Cardiac Arrest