The Latest in Critical Care, 7/3/23 (Issue #7)
Ischemic-reperfusion injury after cardiac arrest can lead to multi-organ failure and worsened cerebral anoxic injury. In observational studies and a phase 2 randomized trial, mild hypercapnia was associated with improved outcomes or biomarkers, perhaps by improving cerebral oxygenation.
In the TAME trial, 1700 patients from 63 ICUs in 17 countries who achieved ROSC after out-of-hospital cardiac arrest were randomized to be ventilated with mild hypercapnia (hypoventilation, with Paco2 50 to 55 mm Hg) or normocapnia (35-45 mm Hg) for the first 24 hours, followed by normocapnia for all patients.
At six months of followup, there was no difference in the rate of good neurologic outcome (43.5% vs 44.6%) or in mortality (48% vs 46%), with normocapnia nominally favored for both outcomes.
This trial doesn’t lead me to diverge from the usual practice of targeting norm…
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