Oxygen Saturation Targets and Neurologic Outcomes Following Cardiac Arrest: A Secondary Analysis of the Pragmatic Investigation of Optimal Oxygen Targets Trial.

Following resuscitation from cardiac arrest, most patients receive mechanical ventilation.

在心脏骤停复苏后，大多数患者接受机械通气。

The oxygenation target that optimizes neurologic outcomes following cardiac arrest is uncertain.

在心脏骤停后，优化神经系统结果的最佳氧合目标尚不明确。

research_question

Following cardiac arrest, does a lower oxygen saturation (Spo2) target improve neurologic outcomes compared with a higher Spo2 target?

在心脏骤停后，较低的氧饱和度（Spo2）目标是否比较高的Spo2目标更能改善神经系统结果？

study_design_and_methods

This study was a secondary analysis of patients who experienced a cardiac arrest prior to enrollment in the Pragmatic Investigation of Optimal Oxygen Targets (PILOT) trial. The PILOT trial assigned critically ill adults receiving mechanical ventilation to a lower (88%-92%), intermediate (92%-96%), or higher (96%-100%) Spo2 target.

本研究是对在参加实用氧饱和度目标研究（PILOT）试验之前经历过心脏骤停的患者进行的二次分析。PILOT试验将接受机械通气的危重成年患者分配到较低（88%-92%）、中等（92%-96%）或较高（96%-100%）的SpO2目标。

This subgroup analysis compared patients randomized to a lower or intermediate Spo2 target (88-96%) vs a higher Spo2 target (96%-100%) regarding the primary outcome of survival with a favorable neurologic outcome at hospital discharge (Cerebral Performance Category 1 or 2).

这项亚组分析比较了随机分配到较低或中等SpO2目标（88-96%）与较高SpO2目标（96%-100%）的患者，关于主要结果为出院时具有良好神经系统结果的存活率（脑功能类别1或2）。

Results

Of 2,987 patients in the PILOT trial, 339 (11.3%) experienced a cardiac arrest prior to enrollment: 221 were assigned to a lower or intermediate Spo2 target, and 118 were assigned to a higher Spo2 target.

在PILOT试验的2,987名患者中，有339名（11.3%）在入组前经历了心脏骤停：其中221名被分配到较低或中等的氧饱和度（Spo2）目标，118名被分配到较高的氧饱和度（Spo2）目标。

Overall, the median age was 60 years, 43.5% were female, 58.7% experienced an in-hospital cardiac arrest, and 10.2% had an initial shockable rhythm.

总体而言，中位年龄为60岁，43.5%为女性，58.7%经历了院内心脏骤停，10.2%最初表现为可电击的心律。

Survival with a favorable neurologic outcome occurred in 50 patients (22.6%) assigned to a lower or intermediate Spo2 target and 15 (12.7%) patients assigned to a higher Spo2 target (absolute risk difference, 9.9 percentage points; 95% CI, 1.8-18.1; P = .03).

在被分配到较低或中等SpO2目标的50名患者（22.6%）和被分配到较高SpO2目标的15名患者（12.7%）中，出现了良好的神经系统结果（绝对风险差异，9.9个百分点；95%置信区间，1.8-18.1；P = .03）。

interpretation

Among patients receiving mechanical ventilation following a cardiac arrest, use of a lower or intermediate Spo2 target was associated with a higher incidenceof a favorable neurologic outcome compared with a higher target.

在心脏骤停后接受机械通气的患者中，使用较低或中等SpO2目标与较高目标相比，与良好神经系统结果的较高发生率相关。

A randomized trial comparing these targets in the cardiac arrest population is needed to confirm these findings.

需要一项随机试验来比较心脏骤停人群中这些目标，以确认这些发现。