Arterial carbon dioxide tension and outcome in patients admitted to the intensive care unit after cardiac arrest

Antoine G. Schneider, Glenn M. Eastwood, Rinaldo Bellomo, Michael Bailey, Miklos Lipcsey, David Pilcher, Paul Young, Peter Stow, John Santamaria, Edward Stachowski, Satoshi Suzuki, Nicholas C. Woinarski, Janine Pilcher

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Abstract

Background: Arterial carbon dioxide tension (PaCO2) affects neuronal function and cerebral blood flow. However, its association with outcome in patients admitted to intensive care unit (ICU) after cardiac arrest (CA) has not been evaluated. Methods and results: Observational cohort study using data from the Australian New Zealand (ANZ) Intensive Care Society Adult-Patient-Database (ANZICS-APD). Outcomes analyses were adjusted for illness severity, co-morbidities, hypothermia, treatment limitations, age, year of admission, glucose, source of admission, PaO2 and propensity score.We studied 16,542 consecutive patients admitted to 125 ANZ ICUs after CA between 2000 and 2011. Using the APD-PaCO2 (obtained within 24h of ICU admission), 3010 (18.2%) were classified into the hypo- (PaCO2<35mmHg), 6705 (40.5%) into the normo- (35-45mmHg) and 6827 (41.3%) into the hypercapnia (>45mmHg) group. The hypocapnia group, compared with the normocapnia group, had a trend toward higher in-hospital mortality (OR 1.12 [95% CI 1.00-1.24, p=0.04]), lower rate of discharge home (OR 0.81 [0.70-0.94, p<0.01]) and higher likelihood of fulfilling composite adverse outcome of death and no discharge home (OR 1.23 [1.10-1.37, p<0.001]). In contrast, the hypercapnia group had similar in-hospital mortality (OR 1.06 [0.97-1.15, p=0.19]) but higher rate of discharge home among survivors (OR 1.16 [1.03-1.32, p=0.01]) and similar likelihood of fulfilling the composite outcome (OR 0.97 [0.89-1.06, p=0.52]). Cox-proportional hazards modelling supported these findings. Conclusions: Hypo- and hypercapnia are common after ICU admission post-CA. Compared with normocapnia, hypocapnia was independently associated with worse clinical outcomes and hypercapnia a greater likelihood of discharge home among survivors.

Original languageEnglish
Pages (from-to)927-934
Number of pages8
JournalResuscitation
Volume84
Issue number7
DOIs
Publication statusPublished - Jul 1 2013
Externally publishedYes

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Keywords

  • Carbon dioxide
  • Cardiac arrest
  • Hypercapnia
  • Hypocapnia
  • Intensive care
  • Mortality
  • Outcome
  • Resuscitation

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Schneider, A. G., Eastwood, G. M., Bellomo, R., Bailey, M., Lipcsey, M., Pilcher, D., Young, P., Stow, P., Santamaria, J., Stachowski, E., Suzuki, S., Woinarski, N. C., & Pilcher, J. (2013). Arterial carbon dioxide tension and outcome in patients admitted to the intensive care unit after cardiac arrest. Resuscitation, 84(7), 927-934. https://doi.org/10.1016/j.resuscitation.2013.02.014