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Critical Care

, 18:555

First Online: 07 October 2014

Abstract

Although experimental studies have suggested that a high arterial oxygen pressure PaO2 might aggravate post-anoxic brain injury, clinical studies in patients resuscitated from cardiac arrest CA have given conflicting results. Some studies found that a PaO2 of more than 300 mm Hg hyperoxemia was an independent predictor of poor outcome, but others reported no association between blood oxygenation and neurological recovery in this setting. In this article, we review the potential mechanisms of oxygen toxicity after CA, animal data available in this field, and key human studies dealing with the impact of oxygen management in CA patients, highlighting some potential confounders and limitations and indicating future areas of research in this field. From the currently available literature, high oxygen concentrations during cardiopulmonary resuscitation seem preferable, whereas hyperoxemia should be avoided in the post-CA care. A specific threshold for oxygen toxicity has not yet been identified. The mechanisms of oxygen toxicity after CA, such as seizure development, reactive oxygen species production, and the development of organ dysfunction, need to be further evaluated in prospective studies.

AbbreviationsABGArterial blood gas

ANZICS-APDAustralian and New Zealand Intensive Care Society-Adult Patient Database

APACHE IIIAcute Physiology and Chronic Health Evaluation III

CACardiac arrest

CIConfidence interval

CPRCardiopulmonary resuscitation

FiO2Inspired oxygen fraction

MOFMultiple organ failure

NSENeuron-specific enolase

OROdds ratio

PaO2Arterial oxygen pressure

PCASPost-cardiac arrest syndrome

ROSReactive oxygen species

ROSCReturn of spontaneous circulation

TTMTarget temperature management

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0555-4 contains supplementary material, which is available to authorized users.

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Author: Antonio Maria Dell’Anna - Irene Lamanna - Jean-Louis Vincent - Fabio Silvio Taccone

Source: https://link.springer.com/







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