Abstract
Aim: To assess the association with outcomes of cardiac index (CI) and mixed venous oxygen saturation (SvO2) in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA). Methods: In the cohort study of 789 patients included in the “BOX”-trial, 565 (77%) patients were included in this hemodynamic substudy (age 62 ± 13 years, male sex 81%). Pulmonary artery catheters were inserted shortly after ICU admission. CI and SvO2 were measured as soon as possible in the ICU and until awakening or death. The endpoints were all-cause mortality at 1 year and renal failure defined as need for renal replacement therapy. Results: First measured CI was median 1.7 (1.4–2.1) l/min/m2, and first measured SvO2 was median 67 (61–73) %. CI < median with SvO2 > median was present in 222 (39%), and low SvO2 with CI < median was present in 59 (11%). Spline analysis indicated that SvO2 value < 55% was associated with poor outcome. Low CI at admission was not significantly associated with mortality in multivariable analysis (p = 0.14). SvO2 was significantly inversely associated with mortality (hazard ratioadjusted: 0.91 (0.84–0.98) per 5% increase in SvO2, p = 0.01). SvO2 was significantly inversely associated with renal failure after adjusting for confounders (ORadjusted: 0.73 [0.62–0.86] per 5% increase in SvO2, p = 0.001). The combination of lower CI and lower SvO2 was associated with higher risk of mortality (hazard ratioadjusted: 1.54 (1.06–2.23) and renal failure (ORadjusted: 5.87 [2.34–14.73]. Conclusion: First measured SvO2 after resuscitation from OHCA was inversely associated with mortality and renal failure. If SvO2 and CI were below median, the risk of poor outcomes increased significantly. Registration: The BOX-trial is registered at clinicaltrials.gov (NCT03141099, date 2017–30–04, retrospectively registered). Graphical abstract: [Figure not available: see fulltext.].
Originalsprog | Engelsk |
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Artikelnummer | 410 |
Tidsskrift | Critical Care |
Vol/bind | 27 |
ISSN | 1364-8535 |
DOI | |
Status | Udgivet - 27. okt. 2023 |
Bibliografisk note
Funding Information:Open access funding provided by Royal Library, Copenhagen University Library Dr. Kjaergaard was supported by an unrestricted grant from the Novo Nordisk Foundation: NNF17OC0028706. Dr Møller has received institutional research grant from Abiomed outside submitted work. Dr. Grands salary is supported by a research grant from the Danish Cardiovascular Academy, funded by the Novo Nordisk Foundation, grant number NNF20SA0067242, and The Danish Heart Foundation. Dr. Hassager was supported by research grants from The Danish Heart Foundation, Lundbeck Foundation (R186-2015–2132) and Novo Nordisk Foundation (NNF20OC0064043).