Article Impact Level: HIGH Data Quality: STRONG Summary of New England Journal of Medicine, NEJMoa2214552. https://doi.org/10.1056/NEJMoa2214552 Dr. Glenn Eastwood et al.
Points
- This research study investigated the impact of mild hypercapnia on neurologic outcomes in comatose adults after out-of-hospital cardiac arrest.
- The study involved 1700 patients from 63 intensive care units in 17 countries, randomly assigned to receive either mild hypercapnia or normocapnia.
- The primary outcome, a favorable neurologic outcome at six months, was observed in similar proportions of patients in the mild hypercapnia (43.5%) and normocapnia (44.6%) groups.
- There was no significant difference in the secondary outcome of death within six months between the mild hypercapnia (48.2%) and normocapnia (45.9%) groups.
- The study concluded that targeted mild hypercapnia did not improve neurologic outcomes compared to normocapnia, suggesting that adherence to normocapnia guidelines is appropriate for post-cardiac arrest coma patients.
Summary
This research paper examines the effects of mild hypercapnia on neurologic outcomes in adults with coma following out-of-hospital cardiac arrest. Current guidelines recommend normocapnia, but mild hypercapnia has been suggested to improve cerebral blood flow and neurologic outcomes. The study randomly assigned adults with coma to either 24 hours of mild hypercapnia or normocapnia and evaluated the primary outcome of a favorable neurologic outcome at six months using the Glasgow Outcome Scale–Extended (GOS-E).
The study involved 1700 patients from 63 intensive care units in 17 countries. Of these, 847 patients were assigned to the mild hypercapnia group, while 853 patients were assigned to the normocapnia group. The primary outcome, a favorable neurologic outcome at six months (GOS-E score of 5 or higher), was observed in 43.5% of patients in the mild hypercapnia group and 44.6% in the normocapnia group. The relative risk was 0.98, indicating no significant difference between the two groups (p=0.76). Additionally, there was no significant difference in the secondary outcome of death within six months between the mild hypercapnia (48.2%) and normocapnia (45.9%) groups.
In conclusion, targeted mild hypercapnia did not improve neurologic outcomes at six months compared to targeted normocapnia in adults with coma following out-of-hospital cardiac arrest. The study findings suggest that adherence to current guidelines recommending normocapnia is appropriate in this patient population. Furthermore, the incidence of adverse events did not differ significantly between the two groups, indicating that mild hypercapnia does not introduce additional risks. These findings provide valuable insights for clinicians involved in managing post-cardiac arrest coma patients.
Link to the article: https://www.nejm.org/doi/10.1056/NEJMoa2214552
References Eastwood, G., Nichol, A. D., Hodgson, C., Parke, R. L., McGuinness, S., Nielsen, N., Bernard, S., Skrifvars, M. B., Stub, D., Taccone, F. S., Archer, J., Kutsogiannis, D., Dankiewicz, J., Lilja, G., Cronberg, T., Kirkegaard, H., Capellier, G., Landoni, G., Horn, J., … Bellomo, R. (2023). Mild hypercapnia or normocapnia after out-of-hospital cardiac arrest. New England Journal of Medicine, NEJMoa2214552. https://doi.org/10.1056/NEJMoa2214552
