Cardiac Arrest and Oxygen: Stephen Bernard
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The document discusses the Avoid Study and its findings on oxygen administration in patients with ST-Elevation Myocardial Infarction (STEMI) and after cardiac arrest. It details trial design, patient characteristics, and outcomes showing varied levels of oxygen saturation and mortality rates. The research highlights the potential benefits of oxygen modulation in critical care settings and ongoing studies to optimize patient outcomes.
Cardiac Arrest and Oxygen: Stephen Bernard
- 1. First, do no oxygen Stephen Bernard MD FACEM FCICM FCCM ASM
- 3. Warren Zapol
- 7. Conclusion A critical care physician can get an arterial line in any artery ……
- 13. Dion Stub, Karen Smith, Stephen Bernard, Ziad Nehme, Michael Stephenson, Janet E. Bray, Peter Cameron, Bill Barger, Andris H. Ellims, Andrew J. Taylor, Ian T. Meredith, David M. Kaye for the AVOID Investigators. Circulation 2015; 131:2143-50 AVOID StudyAVOID Study AAirir VVersusersus OOxygenxygen IIn ST-elevationn ST-elevation MyocarMyocarDDial Infarctionial Infarction
- 14. Trial Design Paramedics Assess Patient Symptoms of STEMI <12 hours, O2 Sats ≥ 94% ST-elevation ≥2 contiguous ECG leads Intended for primary PCI Stub et al. AHJ 2012;163;3;339-345 Clinicaltrials.gov NCT01272713 Exclusion Criteria Oxygen saturation <94% measured on pulse oximeter Oxygen administration prior to randomization Altered conscious state Planned transport to a non-participating hospital
- 15. Characteristic Oxygen Arm N=218 No Oxygen Arm N=223 Status on arrival at the catheterization laboratory Oxygen being administered, %† 95.9 7.7 Oxygen dose, median (IQR)† 8.0 (8.0, 8.0) 4.0 (2.0, 8.0) Pain score, median (IQR) 2.0 (0.0-4.0) 2.0 (0.5-3.5) Time from Paramedic on scene to hospital arrival, median (IQR) 55.0 (46.0, 69.0) 56.5 (48.0, 68.8) Cardiac arrest, % 4.6 3.6 Cardiogenic Shock, % 5.0 5.4 † P for difference <0.05 SpO2 in patients with STEMI P trend <0.05
- 18. Animal studies
- 20. Multicenter retrospective cohort study 120 US hospitals 2001-2005 Non-traumatic cardiac arrest within 24 hours of ICU admission Association between PaO2 of 1st ABG in ICU and in-hospital mortality -Hyperoxia mortality rate 63% -Hypoxia mortality rate 57% -Normoxia mortality rate 45%
- 24. The EXACT pilot study Reduction of oxygen after cardiac arrest Phase 2 study Post VF arrest with pulse oximeter >94% Paramedics randomise O2 to 2L/min or >10L/min Increase to >10L/min if desaturation / re-arrest
- 25. The EXACT pilot study Reduction of oxygen after cardiac arrest 34 patients 5/18 allocated to 2L/min desaturated <94% 0/16 allocated to 10L/min desaturated <94%
- 26. The EXACT Phase 3 study NHMRC funded for 2016-2019 3 States in Australia 1,360 patients post cardiac arrest Sample size based on 35% to 44% survival increase Paramedic randomisation to 4L/min then 2L/min with target O2 sat 90-94% Continue allocation through to ICU
Editor's Notes
- #6: Hct values obtained from northern elephant seal pups during forced diving (n = 3). Diving Hct is significantly different from predive Hct in min 5 and 6. A trend toward a continued increase in Hct during the dive is observed and values returned to predive levels by postdive (PD) min 10 (ANOVA, F(3,8) = 11.01, P = 0.003; Tukey–Kramer HSD, P = 0.05).
- #7: Thoracic images of a northern elephant seal during rest and simulated diving. (Left) Images are from the region immediately caudal to the diaphragm. (Right) Images are 12 cm caudal to the diaphragm. Rapid contraction of the spleen and simultaneous filling of the hepatic sinus are observed.
- #17: 30% of patients in the database had no blood gas data!
- #19: Lipinski – primary hypoxic arrest No therapeutic hypothermia...
- #21: 30% of patients in the database had no blood gas data!