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Oxygen Dose During CPR

Question Type:
Intervention
Full Question:
In adults with cardiac arrest in any setting  (P), does does administering a maximal oxygen concentration (eg, 100% by face mask or closed circuit)  (I), compared with compared with no supplementary oxygen (eg, 21%) or a reduced oxygen concentration (eg, 40%–50%)  (C), change Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, ROSC (O)?
Consensus on Science:
There are no adult human studies that directly compare maximal inspired oxygen with any other inspired oxygen concentration. For the critical outcome of survival to hospital discharge with favorable neurologic outcome (Cerebral Performance Category [CPC] 1 or 2), we identified very-low-quality evidence (downgraded for very serious risk of bias, very serious indirectness, and serious imprecision) from 1 observational study(Spindelboeck 2013, 770) enrolling 145 OHCA patients who had a PaO2 measured during CPR that showed no difference between an intermediate PaO2 and low PaO2 (11/83 [13.3%] versus 1/32 [3.1%]; relative risk [RR], 4.2; 95% CI, 0.57–31.52; P=0.16), or between a high PaO2 and low PaO2 (7/30 [23.3%] versus 1/32 [3.1%]; RR, 7.45; 95% CI, 0.98–57.15; P=0.053). For the important outcome of ROSC, we identified very-low-quality evidence (downgraded for very serious risk of bias, very serious indirectness, and serious imprecision) from 1 observational study(Spindelboeck 2013, 770) enrolling 145 OHCA patients who had a PaO2 measured during CPR that showed improved ROSC in those with a higher PaO2: intermediate PaO2 versus low PaO2 (47/83 [56.6%] versus 7/32 [21.9%]; RR, 2.59; 95% CI, 1.31–5.12; P=0.006); high PaO2 versus low PaO2 (25/30 [83.3%] versus 7/32 [21.9%]; RR, 3.81; 95% CI, 1.94–7.48; P=0.0001); high PaO2 versus intermediate PaO2 (25/30 [83.3%] versus 47/83 [56.6%]; RR, 1.47; 95% CI, 1.15–1.88; P=0.002). In the single identified study, (Spindelboeck 2013, 770) all patients had tracheal intubation and received 100% inspired oxygen during CPR. The worse outcomes associated with a low PaO2 during CPR could be an indication of illness severity.
Treatment Recommendation:
We suggest the use of the highest possible inspired oxygen concentration during CPR (weak recommendation, very-low-quality evidence. Values, Preferences, and Task Force Insights In making this recommendation, we have considered the limited available evidence and the need to correct tissue hypoxia during CPR, and see no reason to change the current treatment recommendation.
CoSTR Attachments:
ALS 889 OxygenduringCPR_JS3Jan2014_new.docx    
ALS 889 Search Strategy.pdf    

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