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Resuscitation. 2018 Jun;127:89-94. doi: 10.1016/j.resuscitation.2018.04.001. Epub 2018 Apr 4.

Preliminary observations in systemic oxygen consumption during targeted temperature management after cardiac arrest.

Author information

1
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02115, USA; Michigan State University College of Human Medicine, 15 Michigan Street NE, Grand Rapids, MI 49503, USA.
2
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02115, USA.
3
Division of Medicine Critical Care, Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
4
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02115, USA; Department of Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02115, USA.
5
Department of Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02115, USA. Electronic address: kberg@bidmc.harvard.edu.

Abstract

AIM:

Limited data suggests low oxygen consumption (VO2), driven by mitochondrial injury, is associated with mortality after cardiac arrest. Due to the challenges of measurement in the critically ill, post-arrest metabolism remains poorly characterized. We monitored VO2, carbon dioxide production (VCO2) and the respiratory quotient (RQ) in post-arrest patients and explored associations with outcome.

METHODS:

Using a gas exchange monitor, we measured continuous VO2 and VCO2 in post- arrest patients treated with targeted temperature management. We used area under the curve and medians over time to evaluate the association between VO2, VCO2, RQ and the VO2:lactate ratio with survival.

RESULTS:

In 17 patients, VO2 in the first 12 h after return of spontaneous circulation (ROSC) was associated with survival (median in survivors 3.35 mL/kg/min [2.98,3.88] vs. non-survivors 2.61 mL/kg/min [2.21,2.94], p = .039). This did not persist over 24 h. The VO2:lactate ratio was associated with survival (median in survivors 1.4 [IQR: 1.1,1.7] vs. non-survivors 0.8 [IQR: 0.6,1.2] p < 0.001). Median RQ was 0.66 (IQR 0.63,0.70) and 71% of RQ measurements were <0.7. Patients with initial RQ < 0.7 had 17% survival versus 64% with initial RQ > 0.7 (p = .131). VCO2 was not associated with survival.

CONCLUSIONS:

There was a significant association between VO2 and mortality in the first 12 h after ROSC, but not over 24 h. Lower VO2: lactate ratio was associated with mortality. A large percentage of patients had RQs below physiologic norms. Further research is needed to explore whether these parameters could have true prognostic value or be a potential treatment target.

KEYWORDS:

Cardiopulmonary resuscitation; Cell respiration; Energy metabolism; Heart arrest; Oxygen consumption

[Indexed for MEDLINE]
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