The effect of hyperoxia on survival following adult cardiac arrest: A systematic review and meta-analysis of observational studies

Chih Hung Wang, Wei Tien Chang, Chien Hua Huang, Min Shan Tsai, Ping Hsun Yu, An Yi Wang, Nai Chuan Chen, Wen Jone Chen

Research output: Contribution to journalReview article

85 Citations (Scopus)

Abstract

Objective: Studies have shown the detrimental effect of hyperoxia in animals with return of spontaneous circulation (ROSC) after cardiac arrest. To maximize the value of existing clinical studies, we performed the systemic review and meta-analysis of human observational studies to examine the effect of hyperoxia on outcomes of post-ROSC patients. Methods: We searched PubMed and Embase from the inception to October 2013. We selected adult observational studies that compared different levels of partial pressure of arterial oxygen (PaO2) in post-ROSC patients with mortality or neurological status at hospital discharge as outcome. Studies comparing hypoxia with normoxia only were excluded. Results: Fourteen studies were identified from 2982 references. Odds ratio (OR) was used as effect estimate. OR was reconstructed if not provided in original articles. Hyperoxia was defined as a PaO2 >300mmHg. Meta-analysis indicated that hyperoxia appeared to be correlated with increased in-hospital mortality (OR, 1.40; 95% CI, 1.02-1.93; I2, 69.27%; 8 studies) but not worsened neurological outcome (OR, 1.62; 95% CI, 0.87-3.02; I2, 55.61%; 2 studies). However, the results were inconsistent in subgroup and sensitivity analyses. Conclusions: Hyperoxia appears to be correlated with increased in-hospital mortality of post-ROSC patients. This result should be interpreted cautiously because of the significant heterogeneity and limited number of studies analyzed. However, because exposure to hyperoxia had no obvious benefits, clinicians should monitor PaO2 closely and titrate oxygen administration cautiously.

Original languageEnglish
Pages (from-to)1142-1148
Number of pages7
JournalResuscitation
Volume85
Issue number9
DOIs
Publication statusPublished - Jan 1 2014
Externally publishedYes

Fingerprint

Hyperoxia
Heart Arrest
Observational Studies
Meta-Analysis
Survival
Odds Ratio
Hospital Mortality
Oxygen
Partial Pressure
PubMed
Mortality

Keywords

  • Cardiopulmonary resuscitation
  • Critical care
  • Emergency medicine
  • Heart arrest
  • Hyperoxia
  • Meta-analysis

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

The effect of hyperoxia on survival following adult cardiac arrest : A systematic review and meta-analysis of observational studies. / Wang, Chih Hung; Chang, Wei Tien; Huang, Chien Hua; Tsai, Min Shan; Yu, Ping Hsun; Wang, An Yi; Chen, Nai Chuan; Chen, Wen Jone.

In: Resuscitation, Vol. 85, No. 9, 01.01.2014, p. 1142-1148.

Research output: Contribution to journalReview article

Wang, Chih Hung ; Chang, Wei Tien ; Huang, Chien Hua ; Tsai, Min Shan ; Yu, Ping Hsun ; Wang, An Yi ; Chen, Nai Chuan ; Chen, Wen Jone. / The effect of hyperoxia on survival following adult cardiac arrest : A systematic review and meta-analysis of observational studies. In: Resuscitation. 2014 ; Vol. 85, No. 9. pp. 1142-1148.
@article{ff94b1f3b18046e28e00874fa20d94e8,
title = "The effect of hyperoxia on survival following adult cardiac arrest: A systematic review and meta-analysis of observational studies",
abstract = "Objective: Studies have shown the detrimental effect of hyperoxia in animals with return of spontaneous circulation (ROSC) after cardiac arrest. To maximize the value of existing clinical studies, we performed the systemic review and meta-analysis of human observational studies to examine the effect of hyperoxia on outcomes of post-ROSC patients. Methods: We searched PubMed and Embase from the inception to October 2013. We selected adult observational studies that compared different levels of partial pressure of arterial oxygen (PaO2) in post-ROSC patients with mortality or neurological status at hospital discharge as outcome. Studies comparing hypoxia with normoxia only were excluded. Results: Fourteen studies were identified from 2982 references. Odds ratio (OR) was used as effect estimate. OR was reconstructed if not provided in original articles. Hyperoxia was defined as a PaO2 >300mmHg. Meta-analysis indicated that hyperoxia appeared to be correlated with increased in-hospital mortality (OR, 1.40; 95{\%} CI, 1.02-1.93; I2, 69.27{\%}; 8 studies) but not worsened neurological outcome (OR, 1.62; 95{\%} CI, 0.87-3.02; I2, 55.61{\%}; 2 studies). However, the results were inconsistent in subgroup and sensitivity analyses. Conclusions: Hyperoxia appears to be correlated with increased in-hospital mortality of post-ROSC patients. This result should be interpreted cautiously because of the significant heterogeneity and limited number of studies analyzed. However, because exposure to hyperoxia had no obvious benefits, clinicians should monitor PaO2 closely and titrate oxygen administration cautiously.",
keywords = "Cardiopulmonary resuscitation, Critical care, Emergency medicine, Heart arrest, Hyperoxia, Meta-analysis",
author = "Wang, {Chih Hung} and Chang, {Wei Tien} and Huang, {Chien Hua} and Tsai, {Min Shan} and Yu, {Ping Hsun} and Wang, {An Yi} and Chen, {Nai Chuan} and Chen, {Wen Jone}",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.resuscitation.2014.05.021",
language = "English",
volume = "85",
pages = "1142--1148",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",
number = "9",

}

TY - JOUR

T1 - The effect of hyperoxia on survival following adult cardiac arrest

T2 - A systematic review and meta-analysis of observational studies

AU - Wang, Chih Hung

AU - Chang, Wei Tien

AU - Huang, Chien Hua

AU - Tsai, Min Shan

AU - Yu, Ping Hsun

AU - Wang, An Yi

AU - Chen, Nai Chuan

AU - Chen, Wen Jone

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objective: Studies have shown the detrimental effect of hyperoxia in animals with return of spontaneous circulation (ROSC) after cardiac arrest. To maximize the value of existing clinical studies, we performed the systemic review and meta-analysis of human observational studies to examine the effect of hyperoxia on outcomes of post-ROSC patients. Methods: We searched PubMed and Embase from the inception to October 2013. We selected adult observational studies that compared different levels of partial pressure of arterial oxygen (PaO2) in post-ROSC patients with mortality or neurological status at hospital discharge as outcome. Studies comparing hypoxia with normoxia only were excluded. Results: Fourteen studies were identified from 2982 references. Odds ratio (OR) was used as effect estimate. OR was reconstructed if not provided in original articles. Hyperoxia was defined as a PaO2 >300mmHg. Meta-analysis indicated that hyperoxia appeared to be correlated with increased in-hospital mortality (OR, 1.40; 95% CI, 1.02-1.93; I2, 69.27%; 8 studies) but not worsened neurological outcome (OR, 1.62; 95% CI, 0.87-3.02; I2, 55.61%; 2 studies). However, the results were inconsistent in subgroup and sensitivity analyses. Conclusions: Hyperoxia appears to be correlated with increased in-hospital mortality of post-ROSC patients. This result should be interpreted cautiously because of the significant heterogeneity and limited number of studies analyzed. However, because exposure to hyperoxia had no obvious benefits, clinicians should monitor PaO2 closely and titrate oxygen administration cautiously.

AB - Objective: Studies have shown the detrimental effect of hyperoxia in animals with return of spontaneous circulation (ROSC) after cardiac arrest. To maximize the value of existing clinical studies, we performed the systemic review and meta-analysis of human observational studies to examine the effect of hyperoxia on outcomes of post-ROSC patients. Methods: We searched PubMed and Embase from the inception to October 2013. We selected adult observational studies that compared different levels of partial pressure of arterial oxygen (PaO2) in post-ROSC patients with mortality or neurological status at hospital discharge as outcome. Studies comparing hypoxia with normoxia only were excluded. Results: Fourteen studies were identified from 2982 references. Odds ratio (OR) was used as effect estimate. OR was reconstructed if not provided in original articles. Hyperoxia was defined as a PaO2 >300mmHg. Meta-analysis indicated that hyperoxia appeared to be correlated with increased in-hospital mortality (OR, 1.40; 95% CI, 1.02-1.93; I2, 69.27%; 8 studies) but not worsened neurological outcome (OR, 1.62; 95% CI, 0.87-3.02; I2, 55.61%; 2 studies). However, the results were inconsistent in subgroup and sensitivity analyses. Conclusions: Hyperoxia appears to be correlated with increased in-hospital mortality of post-ROSC patients. This result should be interpreted cautiously because of the significant heterogeneity and limited number of studies analyzed. However, because exposure to hyperoxia had no obvious benefits, clinicians should monitor PaO2 closely and titrate oxygen administration cautiously.

KW - Cardiopulmonary resuscitation

KW - Critical care

KW - Emergency medicine

KW - Heart arrest

KW - Hyperoxia

KW - Meta-analysis

UR - http://www.scopus.com/inward/record.url?scp=84906047413&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84906047413&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2014.05.021

DO - 10.1016/j.resuscitation.2014.05.021

M3 - Review article

C2 - 24892265

AN - SCOPUS:84906047413

VL - 85

SP - 1142

EP - 1148

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

IS - 9

ER -