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Post-ROSC PaO2

Question Type:
Intervention
Full Question:
Among infants and children with ROSC after cardiac arrest(in- or out-of-hospital setting) (P), does does the use of a targeted PaO2 strategy (I), compared with compared with a strategy of no targeted PaO2 (C), change survival to 180 days with good neurological outcome, survival to 6 months, survival to hospital discharge, survival to ICU discharge, ICU length of stay (O)?
Consensus on Science:
For the critical outcome of survival to hospital discharge with good neurologic outcome, we identified very-low-quality evidence from 1 observational study(Bennett 2013, 1534-1542) of 153 pediatric IHCA and OHCA survivors (downgraded for indirectness, imprecision, and very serious risk of bias) showing no association between post-ROSC normoxemia or hyperoxemia and benefit or harm (RR, 1.27; 95% CI, 0.86–1.90). For the critical outcome of survival to 6 months, we identified very-low-quality evidence from 1 observational study(Guerra-Wallace 2013, e143-e148) of 64 pediatric IHCA and OHCA survivors to PICU admission (downgraded for indirectness, imprecision, and very serious risk of bias) showing no association between post-ROSC normoxemia or hyperoxemia and benefit or harm (RR, 1.09; 95% CI, 0.81–1.46). For the critical outcome of survival to hospital discharge, we identified very-low-quality evidence from 1 observational study(Del Castillo 2012, 1456-1461) of 164 pediatric IHCA survivors (downgraded for indirectness, imprecision, and very serious risk of bias) showing no association between post-ROSC normoxemia or hyperoxemia and benefit or harm (RR, 1.25; 95% CI, 0.76–2.05). For the important outcome of survival to PICU discharge, we identified very-low-quality evidence from 1 observational study(Ferguson 2012, 335-342) of 1427 pediatric IHCA and OHCA survivors to PICU admission (downgraded for indirectness and very serious risk of bias) showing no association between post-ROSC normoxemia or hyperoxemia and benefit or harm (RR, 1.08; 95% CI, 0.95–1.23).
Treatment Recommendation:
We suggest that rescuers measure PaO2 after ROSC and target a value appropriate to the specific patient condition. In the absence of specific patient data, we suggest rescuers target normoxemia after ROSC (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights Accurate targeting of post-ROSC normoxemia might be achievable and acceptable in the in-hospital setting, but its use in the prehospital setting has not been studied and is not without risk to patients of inadvertent hypoxemia. Any titration of oxygen delivery to children after ROSC must be balanced against the risk of inadvertent hypoxemia stemming from overzealous weaning of FIO2. Further challenges for pediatrics include identifying what the appropriate targets should be for specific patient subpopulations (eg, infants and children with cyanotic heart disease).
CoSTR Attachments:
Should normoxemia (Pa02-60 and -300) vs hyperoxemia (Pa02-300) be used in Post-ROSC in Infants and children Recommendations.pdf    
Should normoxemia (Pa02-60 and -300) vs. hyperoxemia (Pa02-300) be used in Post-ROSC in Infants and children GRADE table.pdf    

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