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The association between tidal volume and neurological outcome following in-hospital cardiac arrest.

ABSTRACT: AIMS:Prior investigation has found that mechanical ventilation with lower tidal volumes (Vt) following out-of-hospital cardiac arrest is associated with better neurologic outcomes. The relationship between Vt and neurologic outcome following in-hospital cardiac arrest (IHCA) has not previously been explored. In the present study, we investigate the association between Vt and neurologic outcome following IHCA. METHODS:This was an observational study using a prospectively collected database of IHCA patients at a tertiary care hospital in the United States. The relationship between time-weighted average Vt per predicted body weight (PBW) over the first 6- and 48?h after cardiac arrest and neurologic outcome were assessed using propensity-score adjusted logistic regression. MEASUREMENTS AND MAIN RESULTS:Of 185 IHCA patients who received invasive mechanical ventilation within 6?h of return of spontaneous circulation (ROSC), the average Vt over the first 6?h was 7.7?±?2.0?ml/kg and 68 (36.8%) patients received an average Vt?>?8.0?ml/kg. Of 121 patients who received mechanical ventilation for at least 48?h post-ROSC, the average Vt was 7.6?±?1.5?ml/kg and 46 (38.0%) patients received an average Vt?>?8.0?ml/kg. There was no relationship between Vt/PBW over the first 6- or 48?h post-ROSC and neurologic outcome (OR 0.99; 95%CI 0.84-1.16; p?=?0.89; OR 1.03; 95%CI 0.78-1.37; p?=?0.83 respectively). CONCLUSIONS:This study did not identify a relationship between Vt and neurologic outcome following IHCA. This contrasts with results in OHCA, where higher Vt has been associated with worse neurologic outcome. Additional investigation is needed with respect to other potential benefits of low-Vt post IHCA.

SUBMITTER: Moskowitz A

PROVIDER: S-EPMC6039825 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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The association between tidal volume and neurological outcome following in-hospital cardiac arrest.

Moskowitz Ari A Grossestreuer Anne V AV Berg Katherine M KM Patel Parth V PV Ganley Sarah S Casasola Medrano Marcel M Cocchi Michael N MN Donnino Michael W MW

Resuscitation 20171229

<h4>Aims</h4>Prior investigation has found that mechanical ventilation with lower tidal volumes (Vt) following out-of-hospital cardiac arrest is associated with better neurologic outcomes. The relationship between Vt and neurologic outcome following in-hospital cardiac arrest (IHCA) has not previously been explored. In the present study, we investigate the association between Vt and neurologic outcome following IHCA.<h4>Methods</h4>This was an observational study using a prospectively collected ...[more]

PMID: 29292026

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Project description:(1) Background: Acute respiratory distress syndrome (ARDS) following cardiac arrest is common and associated with in-hospital mortality. We aim to investigate whether lung compliance during targeted temperature management is associated with neurological outcome in patients with ARDS after out-of-hospital cardiac arrest (OHCA). (2) Methods: This observational study is conducted in the emergency intensive care unit from January 2011 to April 2019 using data from a prospective patient registry. Adult patients (age ?18 years) who survived non-traumatic OHCA and subsequently developed ARDS based on the Berlin definition are included. Mechanical ventilator parameters such as plateau pressure, tidal volume, minute ventilation, positive end expiratory pressure, and compliance are recorded for 7 days or until death, and categorized as maximum, median, and minimum. The primary outcome is a favorable neurological outcome defined as a Cerebral Performance Category score of 1 or 2 at hospital discharge. (3) Results: Regarding 246 OHCA survivors, 119 (48.4%) patients developed ARDS. A favorable neurologic outcome was observed in 23 (19.3%). Patients with a favorable outcome have a significantly higher lung compliance (38.6 mL/cm H2O versus 27.5 mL/cm H2O), lower inspiratory pressure (12.0 cm H2O versus 16.0 cm H2O), and lower plateau pressure (17.0 cm H2O versus 21.0 cm H2O) than those with a poor neurologic outcome (all p < 0.01). Concerning time-dependent cox regression models, all maximum (adjusted hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.02-1.09), minimum (HR 1.08, 95% CI 1.03-1.13), and median (HR 1.06, 95% CI 1.02-1.09) compliances are independently associated with a good neurologic outcome. Maximum compliance, >32.5 mL/cm H2O at day 1, has the highest area under the receiver operating characteristic curve (0.745) with a positive predictive value of 90.4%. (4) Conclusions: Lung compliance may be an early predictor of intact neurologic survival in patients with ARDS following cardiac arrest.

Dataset Information

The association between tidal volume and neurological outcome following in-hospital cardiac arrest.

Publications

The association between tidal volume and neurological outcome following in-hospital cardiac arrest.

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