Dataset Information

Oxygen targets following cardiac arrest: A meta-analysis of randomized controlled trials.

ABSTRACT:

Introduction

The appropriate oxygen target post-resuscitation in out-of-hospital cardiac arrest (OHCA) patients is uncertain. We sought to compare lower versus higher oxygen targets in patients following OHCA.

Methods

We searched MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov until January 2023 to include all randomized controlled trials (RCTs) that evaluated conservative vs. liberal oxygen therapy in OHCA patients. Our primary outcome was all-cause mortality at 90 days while our secondary outcomes were the level of neuron-specific enolase (NSE) at 48 h, ICU length of stay (LOS), and favorable neurological outcome (the proportion of patients with Cerebral Performance Category scores of 1-2 at end of follow-up). We used RevMan 5.4 to pool risk ratios (RRs) and mean differences (MDs).

Results

Nine trials with 1971 patients were included in our review. There was no significant difference between the conservative and liberal oxygen target groups regarding the rate of all-cause mortality (RR 0.95, 95% CI: 0.80 to 1.13; I² = 55%). There were no significant differences between the two groups when assessing favorable neurological outcome (RR 1.01, 95% CI: 0.92 to 1.10; I² = 4%), NSE at 48 h (MD 0.04, 95% CI: -0.67 to 0.76; I² = 0%), and ICU length of stay (MD -2.86 days, 95% CI: -8.00 to 2.29 days; I² = 0%).

Conclusions

Conservative oxygen therapy did not decrease mortality, improve neurologic recovery, or decrease ICU LOS as compared to a liberal oxygen regimen. Future large-scale RCTs comparing homogenous oxygen targets are needed to confirm these findings.

SUBMITTER: Cheema HA

PROVIDER: S-EPMC10359856 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Publications

Oxygen targets following cardiac arrest: A meta-analysis of randomized controlled trials.

Cheema Huzaifa Ahmad HA Shafiee Arman A Akhondi Amirhossein A Seighali Niloofar N Shahid Abia A Rehman Mohammad Ebad Ur MEU Almas Talal T Hadeed Sebastian S Nashwan Abdulqadir J AJ Ahmad Soban S

International journal of cardiology. Heart & vasculature 20230705

<h4>Introduction</h4>The appropriate oxygen target post-resuscitation in out-of-hospital cardiac arrest (OHCA) patients is uncertain. We sought to compare lower versus higher oxygen targets in patients following OHCA.<h4>Methods</h4>We searched MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov until January 2023 to include all randomized controlled trials (RCTs) that evaluated conservative vs. liberal oxygen therapy in OHCA patients. Our primary outcome was all-cause mortality at 90 ...[more]

PMID: 37484065

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Project description:BackgroundCurrent 2005 guidelines for advanced cardiac life support strongly recommend immediate defibrillation for out-of-hospital cardiac arrest. However, findings from experimental and clinical studies have indicated a potential advantage of pretreatment with chest compression-only cardiopulmonary resuscitation (CPR) prior to defibrillation in improving outcomes. The aim of this meta-analysis is to evaluate the beneficial effect of chest compression-first versus defibrillation-first on survival in patients with out-of-hospital cardiac arrest.MethodsMain outcome measures were survival to hospital discharge (primary endpoint), return of spontaneous circulation (ROSC), neurologic outcome and long-term survival. Randomized, controlled clinical trials that were published between January 1, 1950, and June 19, 2010, were identified by a computerized search using SCOPUS, MEDLINE, BIOS, EMBASE, the Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts database, and Web of Science and supplemented by conference proceedings. Random effects models were used to calculate pooled odds ratios (ORs). A subgroup analysis was conducted to explore the effects of response interval greater than 5 min on outcomes.ResultsA total of four trials enrolling 1503 subjects were integrated into this analysis. No difference was found between chest compression-first versus defibrillation-first in the rate of return of spontaneous circulation (OR 1.01 [0.82-1.26]; P = 0.979), survival to hospital discharge (OR 1.10 [0.70-1.70]; P = 0.686) or favorable neurologic outcomes (OR 1.02 [0.31-3.38]; P = 0.979). For 1-year survival, however, the OR point estimates favored chest compression first (OR 1.38 [0.95-2.02]; P = 0.092) but the 95% CI crossed 1.0, suggesting insufficient estimate precision. Similarly, for cases with prolonged response times (> 5 min) point estimates pointed toward superiority of chest compression first (OR 1.45 [0.66-3.20]; P = 0.353), but the 95% CI again crossed 1.0.ConclusionsCurrent evidence does not support the notion that chest compression first prior to defibrillation improves the outcome of patients in out-of-hospital cardiac arrest. It appears that both treatments are equivalent. However, subgroup analyses indicate that chest compression first may be beneficial for cardiac arrests with a prolonged response time.

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Dataset Information

Oxygen targets following cardiac arrest: A meta-analysis of randomized controlled trials.

Introduction

Methods

Results

Conclusions

Publications

Oxygen targets following cardiac arrest: A meta-analysis of randomized controlled trials.

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