CPR後不該維持高血氧?看看就好

Hyperoxia After Cardiac Arrest Is Associated with Increased In-Hospital Mortality

Further research is needed to determine optimum oxygenation.

Recent studies have focused on management strategies for improving outcomes after return of spontaneous circulation in patients with cardiac arrest. These authors addressed the effects of postresuscitation oxygenation on mortality.

Researchers used a database of intensive care units (ICUs) at 120 hospitals to study 6326 patients who were older than 17 years, had nontraumatic cardiac arrest, received cardiopulmonary resuscitation (CPR), and underwent arterial blood gas analysis within 24 hours after ICU arrival. Patients were divided into three groups based on oxygenation on the first blood gas result: hyperoxia (PaO2 ≥300 mm Hg; 18% of patients), hypoxia (PaO2 <60 mm Hg or ratio of PaO2 to fraction of inspired oxygen [FiO2] <300; 63%), and normoxia (19%). In-hospital mortality was significantly higher in the hyperoxia group (63%) than in the hypoxia (57%) or normoxia (45%) groups. After adjustment for confounders, the odds ratio for death in patients with hyperoxia compared to those with normoxia was 1.8.

Comment: Although this thought-provoking study shows an association between hyperoxia and increased mortality, the lack of randomization made it impossible for the authors to control for all possible causes of the differences in outcomes between the patient groups, including separating neurological causes of death from other causes. There is no evidence supporting hyperoxia, and ensuring normoxia (PaO2 >60 and ≤300 mm Hg) in patients who are resuscitated from cardiac arrest in the emergency department seems reasonable.

— Diane M. Birnbaumer, MD, FACEP

Published in Journal Watch Emergency Medicine June 11, 2010
Citation(s):

Kilgannon JH et al. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA 2010 Jun 2; 303:2165.

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