Initial Arterial pCO2 and Its Course in the First Hours of Extracorporeal Cardiopulmonary Resuscitation Show No Association with Recovery of Consciousness in Humans: A Single-Centre Retrospective Study

Loes Mandigers; Corstiaan A den Uil; Jeroen J H Bunge; Diederik Gommers; Dinis Dos Reis Miranda

doi:10.3390/membranes11030208

Initial Arterial pCO₂ and Its Course in the First Hours of Extracorporeal Cardiopulmonary Resuscitation Show No Association with Recovery of Consciousness in Humans: A Single-Centre Retrospective Study

Membranes (Basel). 2021 Mar 15;11(3):208. doi: 10.3390/membranes11030208.

Authors

Loes Mandigers¹, Corstiaan A den Uil^{1

2}, Jeroen J H Bunge^{1

2}, Diederik Gommers¹, Dinis Dos Reis Miranda¹

Affiliations

¹ Department of Intensive Care, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands.
² Department of Cardiology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands.

Abstract

Background: Cardiac arrest is a severe condition with high mortality rates, especially in the case of prolonged low-flow durations resulting in severe ischaemia and reperfusion injury. Changes in partial carbon dioxide concentration (pCO₂) may aggravate this injury. Extracorporeal cardiopulmonary resuscitation (ECPR) shortens the low-flow duration and enables close regulation of pCO₂. We examined whether pCO₂ is associated with recovery of consciousness.

Methods: We retrospectively analysed ECPR patients ≥ 16 years old treated between 2010 and 2019. We evaluated initial arterial pCO₂ and the course of pCO₂ ≤ 6 h after initiation of ECPR. The primary outcome was the rate of recovery of consciousness, defined as Glasgow coma scale motor score of six.

Results: Out of 99 ECPR patients, 84 patients were eligible for this study. The mean age was 47 years, 63% were male, 93% had a witnessed arrest, 45% had an out-of-hospital cardiac arrest, and 38% had a recovery of consciousness. Neither initial pCO₂ (Odds Ratio (OR) 0.93, 95% confidence interval 95% (CI) 0.78-1.08) nor maximum decrease of pCO₂ (OR 1.03, 95% CI 0.95-1.13) was associated with the recovery of consciousness.

Conclusion: Initial arterial pCO₂ and the course of pCO₂ in the first six hours after initiation of ECPR were not associated with the recovery of consciousness.

Keywords: carbon dioxide; cardiac arrest; extracorporeal cardiopulmonary resuscitation; extracorporeal membrane oxygenation; heart arrest; outcome.