Effect of Oxygen Saturation Targets on Neurologic Outcomes after Cardiac Arrest: A Secondary Analysis of the PILOT Trial

  1. Stephanie C. DeMasi
  2. Alexander T. Clark
  3. Amelia L. Muhs
  4. Jin H. Han
  5. Kipp Shipley
  6. Jared J. McKinney
  7. Li Wang
  8. Todd W. Rice
  9. Ari Moskowitz
  10. Matthew E. Prekker
  11. Nicholas J Johnson
  12. Wesley H. Self
  13. Jonathan D. Casey
  14. Matthew W. Semler
  15. Kevin P. Seitz
  16. Pragmatic Critical Care Research Group
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Abstract

Background

More than 600,000 adults in the United States experience a cardiac arrest each year. After resuscitation from cardiac arrest, most patients receive mechanical ventilation. The oxygenation target that optimizes neurologic outcomes after cardiac arrest is uncertain.

Research Question

After cardiac arrest, does a lower oxygen saturation (SpO2) target improve neurologic outcomes compared to a higher SpO2target?

Study Design and Methods

We conducted a secondary analysis of patients who experienced a cardiac arrest before enrollment in the Pragmatic Investigation of optimal Oxygen Targets (PILOT) trial. The PILOT trial assigned critically ill adults receiving mechanical ventilation to a lower (88-92%), intermediate, (92-96%), or higher (96-100%) SpO2target. This subgroup analysis compared patients randomized to a lower-or-intermediate SpO2target (88-96%) versus a higher SpO2target (96-100%) with regard to the primary outcome of survival with a favorable neurologic outcome at hospital discharge (Cerebral Performance Category 1 or 2). The secondary outcome was in-hospital death.

Results

Of 2,987 patients in the PILOT trial, 339 (11.3%) experienced a cardiac arrest before enrollment: 221 were assigned to a lower-or-intermediate SpO2target, and 118 were assigned to a higher SpO2target. Overall, the median age was 60 years, 43.5% were female, 58.7% experienced an in-hospital cardiac arrest, and 10.2% had an initial shockable rhythm. Survival with a favorable neurologic outcome occurred in 50 patients (22.6%) assigned to a lower-or-intermediate SpO2target and 15 (12.7%) patients assigned to a higher SpO2target (P=0.03). In-hospital death occurred in 146 patients (66.1%) assigned to a lower-or-intermediate SpO2target and 89 (75.4%) assigned to a higher target (P=0.08).

Interpretation

Among patients receiving mechanical ventilation after a cardiac arrest, use of a lower-or-intermediate SpO2target was associated with a higher incidence of a favorable neurologic outcome compared with a higher target. A randomized trial comparing these targets in the cardiac arrest population is needed to confirm these findings.

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