Association between PaCO2 and outcomes in patients who underwent extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest

• Published in: Acute medicine & surgery 2024-01, Vol.11 (1), p.e70021-n/a
• Main Authors: Kawakami, Ayumi, Shibahashi, Keita, Sugiyama, Kazuhiro, Hifumi, Toru, Inoue, Akihiko, Sakamoto, Tetsuya, Kuroda, Yasuhiro, Sawano, Hirotaka, Egawa, Yuko, Kato, Shunichi, Tanabe, Maki, Bunya, Naofumi, Kasai, Takehiko, Ijuin, Shinichi, Nakayama, Shinichi, Kanda, Jun, Kanou, Seiya, Takiguchi, Toru, Yokobori, Shoji, Takada, Hiroaki, Inoue, Kazushige, Takeuchi, Ichiro, Honzawa, Hiroshi, Kobayashi, Makoto, Hamagami, Tomohiro, Takayama, Wataru, Otomo, Yasuhiro, Maekawa, Kunihiko, Shimizu, Takafumi, Nara, Satoshi, Nasu, Michitaka, Takahashi, Kuniko, Hagiwara, Yoshihiro, Kushimoto, Shigeki, Fukuda, Reo, Ogura, Takayuki, Shiraishi, Shin‐ichiro, Zushi, Ryosuke, Otani, Norio, Okamoto, Hiroshi, Kikuchi, Migaku, Watanabe, Kazuhiro, Nakagami, Takuo, Shoko, Tomohisa, Kitamura, Nobuya, Otani, Takayuki, Matsuoka, Yoshinori, Aoki, Makoto, Sakuraya, Masaaki, Arimoto, Hideki, Homma, Koichiro, Naito, Hiromichi, Nakao, Shunichiro, Okazaki, Tomoya, Kunikata, Jun, Yokoi, Hideto, Tahara, Yoshio
• Format: Article
• Language: English
• Subjects: Activities of daily living; arterial partial pressure of carbon dioxide; Cardiac arrest; Cardiac arrhythmia; Cardiopulmonary resuscitation; Clinical outcomes; CPR; Emergency medical care; extracorporeal cardiopulmonary resuscitation; Extracorporeal membrane oxygenation; intensive care unit; neurological outcome; out‐of‐hospital cardiac arrest; Patients
• ISSN: 2052-8817; 2052-8817
• DOI: 10.1002/ams2.70021

Aim The optimal arterial partial pressure of carbon dioxide (PaCO2) for patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) remains unknown. We aimed to investigate the association between post‐resuscitation PaCO2 and neurological outcomes. Methods This retrospective cohort study analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan, a multicenter registry study across 36 hospitals in Japan, including patients with out‐of‐hospital cardiac arrest (OHCA) admitted to intensive care units (ICU) after ECPR between 2013 and 2018. Good PaCO2 management status was defined as a PaCO2 value of 35–45 mmHg. We classified patients into four groups (poor–poor, poor–good, good–poor, and good–good) according to their PaCO2 management status upon admission at the ICU and the following day. The primary outcome was a favorable neurological outcome, defined as cerebral performance category 1 or 2, 30 days after cardiac arrest. The secondary outcome was survival 30 days after cardiac arrest. Results We classified 885 eligible patients into poor–poor (n = 361), poor–good (n = 231), good–poor (n = 155), and good–good (n = 138) groups. No significant association was observed between PaCO2 management and favorable 30‐day neurological outcomes. Compared with the poor–poor group, the poor–good, good–poor, and good–good groups had adjusted odds ratios of 0.87 (95% confidence interval, 0.52–1.44), 1.17 (0.65–2.05), and 0.95 (0.51–1.73), respectively. The 30‐day survival rates among the four groups did not differ significantly. Conclusion PaCO2 values were not significantly associated with 30‐day neurological outcomes or survival of patients with OHCA after ECPR. Analysis of 885 patients from SAVE‐J II database in Japan revealed no significant associations between PaCO2 values and 30‐day neurological outcomes or survival of patients who underwent extracorporeal cardiopulmonary resuscitation for out‐of‐hospital cardiac arrest.