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Controlled Oxygenation after Cardiac Arrest

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Annual Update in Intensive Care and Emergency Medicine 2012

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM,volume 2012))

Abstract

Sudden cardiac arrest is the most common lethal manifestation of cardiovascular disease. Even when successfully resuscitated and admitted to the intensive care unit (ICU), the majority of patients do not survive [1]. This disappointingly low survival rate has resulted in a shift of focus from interventions that improve success of cardiopulmonary resuscitation (CPR) to factors that may modify outcome favorably after return of spontaneous circulation (ROSC) [2]. Whilst early restoration of blood flow to ischemic tissues is essential to halt progression of cellular damage, it is now clear that reperfusion initiates a complex series of reactions that paradoxically injure tissues. This global ischemia/reperfusion response is responsible for the post-cardiac arrest syndrome observed in survivors of cardiac arrest [3]. The brain is particularly vulnerable to ischemia/reperfusion and postcardiac arrest brain injury is the most common cause of death and disability [4]. The recent success of therapeutic hypothermia has emphasized that the course of reperfusion injury can be mitigated and as such the search for other interventions that may further attenuate injury and improve outcome has focused recently on the high concentrations of oxygen administered routinely during CPR and for prolonged periods after ROSC.

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References

  1. Nolan JP, Soar J (2010) Postresuscitation care: entering a new era. Curr Opin Crit Care 16: 216–222

    Article  PubMed  Google Scholar 

  2. Peberdy MA, Callaway CW, Neumar RW, et al (2010) Part 9: Post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122: S768–786

    Article  Google Scholar 

  3. Nolan JP, Neumar RW, Adrie C, et al (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke. Resuscitation 79: 350–379

    Article  PubMed  Google Scholar 

  4. Laver S, Farrow C, Turner D, Nolan J (2004) Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med 30: 2126–2128

    Article  PubMed  Google Scholar 

  5. Lewen A, Matz P, Chan PH (2000) Free radical pathways in CNS injury. J Neurotrauma 17: 871–890

    Article  PubMed  CAS  Google Scholar 

  6. Fiskum G, Danilov CA, Mehrabian Z, et al (2008) Postischemic oxidative stress promotes mitochondrial metabolic failure in neurons and astrocytes. Ann NY Acad Sci 1147: 129–138

    Article  PubMed  CAS  Google Scholar 

  7. Nakka VP, Gusain A, Mehta SL, Raghubir R (2008) Molecular mechanisms of apoptosis in cerebral ischemia: multiple neuroprotective opportunities. Mol Neurobiol 37: 7–38

    Article  PubMed  CAS  Google Scholar 

  8. Wolbarsht ML, Fridovich I (1989) Hyperoxia during reperfusion is a factor in reperfusion injury. Free Radic Biol Med 6: 61–62

    Article  PubMed  CAS  Google Scholar 

  9. Imberti R, Bellinzona G, Riccardi F, Pagani M, Langer M (2003) Cerebral perfusion pressure and cerebral tissue oxygen tension in a patient during cardiopulmonary resuscitation. Intensive Care Med 29: 1016–1019

    PubMed  Google Scholar 

  10. Gerschman R, Gilbert DL, Nye SW, Dwyer P, Fenn WO (1954) Oxygen poisoning and xirradiation: a mechanism in common. Science 119: 623–626

    Article  PubMed  CAS  Google Scholar 

  11. Davis PG, Tan A, O’Donnell CPF, Schulze A (2004) Resuscitation of newborn infants with 100 % oxygen or air: a systematic review and meta-analysis. Lancet 364: 1329–1333

    Article  PubMed  Google Scholar 

  12. Conti CR (2011) Is hyperoxic ventilation important to treat acute coronary syndromes such as myocardial infarction? Clin Cardiol 34: 132–133

    Article  PubMed  Google Scholar 

  13. Michalski D, Hartig W, Schneider D, Hobohm C (2011) Use of normobaric and hyperbaric oxygen in acute focal cerebral ischemia — a preclinical and clinical review. Acta Neurol Scand 123: 85–97

    Article  PubMed  CAS  Google Scholar 

  14. Neumar RW (2011) Optimal oxygenation during and after cardiopulmonary resuscitation. Curr Opin Crit Care 17: 236–240

    Article  PubMed  Google Scholar 

  15. Nolan JP, Soar J, Zideman DA, et al (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 81: 1219–1276

    Article  PubMed  Google Scholar 

  16. O’Driscoll BR, Howard LS, Davison AG (2008) BTS guideline for emergency oxygen use in adult patients. Thorax 63 (Suppl) 6: vi1–68

    Article  Google Scholar 

  17. Marsala J, Marsala M, Vanicky I, Galik J, Orendacova J (1992) Post cardiac arrest hyperoxic resuscitation enhances neuronal vulnerability of the respiratory rhythm generator and some brainstem and spinal cord neuronal pools in the dog. Neurosci Lett 146: 121–124

    Article  PubMed  CAS  Google Scholar 

  18. Liu Y, Rosenthal RE, Haywood Y, Miljkovic-Lolic M, Vanderhoek JY, Fiskum G (1998) Normoxic ventilation after cardiac arrest reduces oxidation of brain lipids and improves neurological outcome. Stroke 29: 1679–1686

    Article  PubMed  CAS  Google Scholar 

  19. Richards EM, Rosenthal RE, Kristian T, Fiskum G (2006) Postischemic hyperoxia reduces hippocampal pyruvate dehydrogenase activity. Free Radic Biol Med 40: 1960–1970

    Article  PubMed  CAS  Google Scholar 

  20. Vereczki V, Martin E, Rosenthal RE, Hof PR, Hoffman GE, Fiskum G (2006) Normoxic resuscitation after cardiac arrest protects against hippocampal oxidative stress, metabolic dysfunction, and neuronal death. J Cereb Blood Flow Metab 26: 821–835

    Article  PubMed  CAS  Google Scholar 

  21. Richards EM, Fiskum G, Rosenthal RE, Hopkins I, Mckenna MC (2007) Hyperoxic reperfusion after global ischemia decreases hippocampal energy metabolism. Stroke 38: 1578–1584

    Article  PubMed  Google Scholar 

  22. Mickel HS, Vaishnav YN, Kempski O, von Lubitz D, Weiss JF, Feuerstein G (1987) Breathing 100% oxygen after global brain ischemia in Mongolian Gerbils results in increased lipid peroxidation and increased mortality. Stroke 18: 426–430

    Article  PubMed  CAS  Google Scholar 

  23. Feng ZC, Sick TJ, Rosenthal M (1998) Oxygen sensitivity of mitochondrial redox status and evoked potential recovery early during reperfusion in post-ischemic rat brain. Resuscitation 37: 33–41

    Article  PubMed  CAS  Google Scholar 

  24. Walson KH, Tang M, Glumac A, et al (2011) Normoxic versus hyperoxic resuscitation in pediatric asphyxial cardiac arrest: effects on oxidative stress. Crit Care Med 39: 335–343

    Article  PubMed  CAS  Google Scholar 

  25. Balan IS, Fiskum G, Hazelton J, Cotto-Cumba C, Rosenthal RE (2006) Oximetry-guided reoxygenation improves neurological outcome after experimental cardiac arrest. Stroke 37: 3008–3013

    Article  PubMed  Google Scholar 

  26. Brucken A, Kaab AB, Kottmann K, et al (2010) Reducing the duration of 100 % oxygen ventilation in the early reperfusion period after cardiopulmonary resuscitation decreases striatal brain damage. Resuscitation 81: 1698–1703

    Article  PubMed  Google Scholar 

  27. Hazelton JL, Balan I, Elmer GI, et al (2010) Hyperoxic reperfusion after global cerebral ischemia promotes inflammation and long-term hippocampal neuronal death. J Neurotrauma 27: 753–762

    Article  PubMed  Google Scholar 

  28. Zwemer CF, Whitesall SE, D’Alecy LG (1994) Cardiopulmonary-cerebral resuscitation with 100 % oxygen exacerbates neurological dysfunction following nine minutes of normothermic cardiac arrest in dogs. Resuscitation 27: 159–170

    Article  PubMed  CAS  Google Scholar 

  29. Douzinas EE, Patsouris E, Kypriades EM, et al (2001) Hypoxaemic reperfusion ameliorates the histopathological changes in the pig brain after a severe global cerebral ischaemic insult. Intensive Care Med 27: 905–910

    Article  PubMed  CAS  Google Scholar 

  30. Lipinski CA, Hicks SD, Callaway CW (1999) Normoxic ventilation during resuscitation and outcome from asphyxial cardiac arrest in rats. Resuscitation 42: 221–229

    Article  PubMed  CAS  Google Scholar 

  31. Douzinas EE, Andrianakis I, Pitaridis MT, et al (2001) The effect of hypoxemic reperfusion on cerebral protection after a severe global ischemic brain insult. Intensive Care Med 27: 269–275

    Article  PubMed  CAS  Google Scholar 

  32. Zwemer CF, Whitesall SE, D’Alecy LG (1995) Hypoxic cardiopulmonary-cerebral resuscitation fails to improve neurological outcome following cardiac arrest in dogs. Resuscitation 29: 225–236

    Article  PubMed  CAS  Google Scholar 

  33. Kuisma M, Boyd J, Voipio V, Alaspää A, Roine RO, Rosenberg P (2006) Comparison of 30 and the 100 % inspired oxygen concentrations during early post-resuscitation period: a randomised controlled pilot study. Resuscitation 69: 199–206

    Article  PubMed  CAS  Google Scholar 

  34. Kilgannon JH, Jones AE, Shapiro NI, et al (2010) Association Between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA 303: 2165–2171

    Article  PubMed  CAS  Google Scholar 

  35. Bellomo R, Bailey M, Eastwood GM, et al (2011) Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest. Crit Care 15: R90

    Article  PubMed  Google Scholar 

  36. Kilgannon JH, Jones AE, Parrillo JE, et al (2011) Relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest. Circulation 123: 2717–2722

    Article  PubMed  CAS  Google Scholar 

  37. Rosenthal RE, Silbergleit R, Hof PR, Haywood Y, Fiskum G (2003) Hyperbaric oxygen reduces neuronal death and improves neurological outcome after canine cardiac arrest. Stroke 34: 1311–1316

    Article  PubMed  Google Scholar 

  38. Eltzschig HK, Carmeliet P (2011) Hypoxia and inflammation. N Engl J Med 364: 656–665

    Article  PubMed  CAS  Google Scholar 

  39. Iscoe S, Beasley R, Fisher JA (2011) Supplementary oxygen for nonhypoxemic patients: O2 much of a good thing? Crit Care 15: 305

    Article  PubMed  Google Scholar 

  40. Farquhar H, Weatherall M, Wijesinghe M, et al (2009) Systematic review of studies of the effect of hyperoxia on coronary blood flow. Am Heart J 158: 371–377

    Article  PubMed  CAS  Google Scholar 

  41. Bourassa MG, Campeau L, Bois MA, Rico O (1969) The effects of inhalation of 100 percent oxygen on myocardial lactate metabolism in coronary heart disease. Am J Cardiol 24: 172–177

    Article  PubMed  CAS  Google Scholar 

  42. Rawles JM, Kenmure AC, (1976) Controlled trial of oxygen in uncomplicated myocardial infarction. BMJ 1: 1121–1123

    Article  PubMed  CAS  Google Scholar 

  43. Wijesinghe M, Perrin K, Ranchord A, Simmonds M, Weatherall M, Beasley R (2009) Routine use of oxygen in the treatment of myocardial infarction: systematic review. Heart 95: 198–202

    Article  PubMed  CAS  Google Scholar 

  44. Cabello JB, Burls A, Emparanza JI, Bayliss S, Quinn T (2010) Oxygen therapy for acute myocardial infarction. Cochrane Database Syst Rev 6: CD007160

    PubMed  Google Scholar 

  45. Vento M, Asensi M, Sastre J, Garcia-Sala F, Pallardo FV, Vina J (2001) Resuscitation with room air instead of 100 % oxygen prevents oxidative stress in moderately asphyxiated term neonates. Pediatrics 107: 642–647

    Article  PubMed  CAS  Google Scholar 

  46. Saugstad OD, Ramji S, Soll RF, Vento M (2008) Resuscitation of newborn infants with 21 % or 100 % oxygen: an updated systematic review and meta-analysis. Neonatology 94: 176–182

    Article  PubMed  CAS  Google Scholar 

  47. Saugstad OD (2007) Optimal oxygenation at birth and in the neonatal period. Neonatology 91: 319–322

    Article  PubMed  CAS  Google Scholar 

  48. Bennett MH, Wasiak J, Schnabel A, Kranke P, French C (2005) Hyperbaric oxygen therapy for acute ischaemic stroke. Cochrane Database Syst Rev CD004954

    Google Scholar 

  49. Adams HP Jr, del Zoppo G, Alberts MJ, et al (2007) Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation 115: e478–534

    Article  PubMed  Google Scholar 

  50. Singhal AB, Benner T, Roccatagliata L, et al (2005) A pilot study of normobaric oxygen therapy in acute ischemic stroke. Stroke 36: 797–802

    Article  PubMed  Google Scholar 

  51. Singhal AB, Ratai E, Benner T, et al (2007) Magnetic resonance spectroscopy study of oxygen therapy in ischemic stroke. Stroke 38: 2851–2854

    Article  PubMed  CAS  Google Scholar 

  52. Chiu EH, Liu CS, Tan TY, Chang KC (2006) Venturi mask adjuvant oxygen therapy in severe acute ischemic stroke. Arch Neurol 63: 741–744

    Article  PubMed  Google Scholar 

  53. Ronning OM, Guldvog B (1999) Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial. Stroke 30: 2033–2037

    Article  PubMed  CAS  Google Scholar 

  54. Singhal AB, Lo EH, Dalkara T, Moskowitz MA (2005) Advances in stroke neuroprotection: hyperoxia and beyond. Neuroimaging Clin N Am 15: 697–720

    Article  PubMed  Google Scholar 

  55. Rink C, Roy S, Khan M, Ananth P, Kuppusamy P, Sen CK, Khanna S (2010) Oxygen-sensitive outcomes and gene expression in acute ischemic stroke. J Cereb Blood Flow Metab 30: 1275–1287

    Article  PubMed  CAS  Google Scholar 

  56. Rha JH, Saver JL (2007) The impact of recanalization on ischemic stroke outcome: a metaanalysis. Stroke 38: 967–973

    Article  PubMed  Google Scholar 

  57. Diringer MN (2008) Hyperoxia: good or bad for the injured brain? Current Opinion in Critical Care 14: 167–171

    Article  PubMed  Google Scholar 

  58. Altemeier WA, Sinclair SE (2007) Hyperoxia in the intensive care unit: why more is not always better. Curr Opin Crit Care 13: 73–78

    Article  PubMed  Google Scholar 

  59. de Jonge E, Peelen L, Keijzers PJ, et al (2008) Association between administered oxygen, arterial partial oxygen pressure and mortality in mechanically ventilated intensive care unit patients. Crit Care 12: R156

    Article  PubMed  Google Scholar 

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Authors
  1. C. E. Hommers
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  2. J. P. Nolan
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Editors and Affiliations

  1. Department of Intensive Care Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Head) (Head)

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Hommers, C.E., Nolan, J.P. (2012). Controlled Oxygenation after Cardiac Arrest. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2012. Annual Update in Intensive Care and Emergency Medicine, vol 2012. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-25716-2_47

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  • DOI: https://doi.org/10.1007/978-3-642-25716-2_47

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-25715-5

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