A systematic review and meta-analysis of the association between arterial carbon dioxide tension and outcomes after cardiac arrest

Nicole McKenzie, Teresa A. Williams, Hideo Tohira, Kwok M. Ho, Judith Finn

Research output: Contribution to journalReview article

19 Citations (Scopus)

Abstract

Introduction Arterial carbon dioxide tension (PaCO2) abnormalities are common after cardiac arrest (CA). Maintaining a normal PaCO2 makes physiological sense and is recommended as a therapeutic target after CA, but few studies have examined the association between PaCO2 and patient outcomes. This systematic review and meta-analysis aimed to assess the effect of a low or high PaCO2 on patient outcomes after CA. Methods We searched MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL, for studies that evaluated the association between PaCO2 and outcomes after CA. The primary outcome was hospital survival. Secondary outcomes included neurological status at the end of each study's follow up period, hospital discharge destination and 30-day survival. Meta-analysis was conducted if statistical heterogeneity was low. Results The systematic review included nine studies; eight provided sufficient quantitative data for meta-analysis. Using PaCO2 cut-points of <35 mmHg and >45 mmHg to define hypo- and hypercarbia, normocarbia was associated with increased hospital survival (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.23, 1.38). Normocarbia was also associated with a good neurological outcome (cerebral performance category score 1 or 2) compared to hypercarbia (OR 1.69, 95% CI 1.13, 2.51) when the analysis also included an additional study with a slightly different definition for normocarbia (PaCO2 30–50 mmHg). Conclusions From the limited data it appears PaCO2 has an important U-shape association with survival and outcomes after CA, consistent with international resuscitation guidelines’ recommendation that normocarbia be targeted during post-resuscitation care.

Original languageEnglish
Pages (from-to)116-126
Number of pages11
JournalResuscitation
Volume111
Early online date30 Sep 2016
DOIs
Publication statusPublished - 1 Feb 2017

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Heart Arrest
Carbon Dioxide
Meta-Analysis
Survival
Hypercapnia
Resuscitation
Odds Ratio
Confidence Intervals
MEDLINE
Guidelines
Therapeutics

Cite this

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title = "A systematic review and meta-analysis of the association between arterial carbon dioxide tension and outcomes after cardiac arrest",
abstract = "Introduction Arterial carbon dioxide tension (PaCO2) abnormalities are common after cardiac arrest (CA). Maintaining a normal PaCO2 makes physiological sense and is recommended as a therapeutic target after CA, but few studies have examined the association between PaCO2 and patient outcomes. This systematic review and meta-analysis aimed to assess the effect of a low or high PaCO2 on patient outcomes after CA. Methods We searched MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL, for studies that evaluated the association between PaCO2 and outcomes after CA. The primary outcome was hospital survival. Secondary outcomes included neurological status at the end of each study's follow up period, hospital discharge destination and 30-day survival. Meta-analysis was conducted if statistical heterogeneity was low. Results The systematic review included nine studies; eight provided sufficient quantitative data for meta-analysis. Using PaCO2 cut-points of <35 mmHg and >45 mmHg to define hypo- and hypercarbia, normocarbia was associated with increased hospital survival (odds ratio [OR] 1.30, 95{\%} confidence interval [CI] 1.23, 1.38). Normocarbia was also associated with a good neurological outcome (cerebral performance category score 1 or 2) compared to hypercarbia (OR 1.69, 95{\%} CI 1.13, 2.51) when the analysis also included an additional study with a slightly different definition for normocarbia (PaCO2 30–50 mmHg). Conclusions From the limited data it appears PaCO2 has an important U-shape association with survival and outcomes after CA, consistent with international resuscitation guidelines’ recommendation that normocarbia be targeted during post-resuscitation care.",
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A systematic review and meta-analysis of the association between arterial carbon dioxide tension and outcomes after cardiac arrest. / McKenzie, Nicole; Williams, Teresa A.; Tohira, Hideo; Ho, Kwok M.; Finn, Judith.

In: Resuscitation, Vol. 111, 01.02.2017, p. 116-126.

Research output: Contribution to journalReview article

TY - JOUR

T1 - A systematic review and meta-analysis of the association between arterial carbon dioxide tension and outcomes after cardiac arrest

AU - McKenzie, Nicole

AU - Williams, Teresa A.

AU - Tohira, Hideo

AU - Ho, Kwok M.

AU - Finn, Judith

PY - 2017/2/1

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N2 - Introduction Arterial carbon dioxide tension (PaCO2) abnormalities are common after cardiac arrest (CA). Maintaining a normal PaCO2 makes physiological sense and is recommended as a therapeutic target after CA, but few studies have examined the association between PaCO2 and patient outcomes. This systematic review and meta-analysis aimed to assess the effect of a low or high PaCO2 on patient outcomes after CA. Methods We searched MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL, for studies that evaluated the association between PaCO2 and outcomes after CA. The primary outcome was hospital survival. Secondary outcomes included neurological status at the end of each study's follow up period, hospital discharge destination and 30-day survival. Meta-analysis was conducted if statistical heterogeneity was low. Results The systematic review included nine studies; eight provided sufficient quantitative data for meta-analysis. Using PaCO2 cut-points of <35 mmHg and >45 mmHg to define hypo- and hypercarbia, normocarbia was associated with increased hospital survival (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.23, 1.38). Normocarbia was also associated with a good neurological outcome (cerebral performance category score 1 or 2) compared to hypercarbia (OR 1.69, 95% CI 1.13, 2.51) when the analysis also included an additional study with a slightly different definition for normocarbia (PaCO2 30–50 mmHg). Conclusions From the limited data it appears PaCO2 has an important U-shape association with survival and outcomes after CA, consistent with international resuscitation guidelines’ recommendation that normocarbia be targeted during post-resuscitation care.

AB - Introduction Arterial carbon dioxide tension (PaCO2) abnormalities are common after cardiac arrest (CA). Maintaining a normal PaCO2 makes physiological sense and is recommended as a therapeutic target after CA, but few studies have examined the association between PaCO2 and patient outcomes. This systematic review and meta-analysis aimed to assess the effect of a low or high PaCO2 on patient outcomes after CA. Methods We searched MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL, for studies that evaluated the association between PaCO2 and outcomes after CA. The primary outcome was hospital survival. Secondary outcomes included neurological status at the end of each study's follow up period, hospital discharge destination and 30-day survival. Meta-analysis was conducted if statistical heterogeneity was low. Results The systematic review included nine studies; eight provided sufficient quantitative data for meta-analysis. Using PaCO2 cut-points of <35 mmHg and >45 mmHg to define hypo- and hypercarbia, normocarbia was associated with increased hospital survival (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.23, 1.38). Normocarbia was also associated with a good neurological outcome (cerebral performance category score 1 or 2) compared to hypercarbia (OR 1.69, 95% CI 1.13, 2.51) when the analysis also included an additional study with a slightly different definition for normocarbia (PaCO2 30–50 mmHg). Conclusions From the limited data it appears PaCO2 has an important U-shape association with survival and outcomes after CA, consistent with international resuscitation guidelines’ recommendation that normocarbia be targeted during post-resuscitation care.

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DO - 10.1016/j.resuscitation.2016.09.019

M3 - Review article

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JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

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