Conservative or liberal oxygen therapy in adults after cardiac arrest An individual-level patient data meta-analysis of randomised controlled trials

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Young , P J , Bailey , M , Bellomo , R , Bernard , S , Bray , J , Jakkula , P , Kuisma , M , Mackle , D , Martin , D , Nolan , J P , Panwar , R , Reinikainen , M , Skrifvars , M B & Thomas , M 2020 , ' Conservative or liberal oxygen therapy in adults after cardiac arrest An individual-level patient data meta-analysis of randomised controlled trials ' , Resuscitation , vol. 157 , pp. 15-22 . https://doi.org/10.1016/j.resuscitation.2020.09.036

Title: Conservative or liberal oxygen therapy in adults after cardiac arrest An individual-level patient data meta-analysis of randomised controlled trials
Author: Young, Paul J.; Bailey, Michael; Bellomo, Rinaldo; Bernard, Stephen; Bray, Janet; Jakkula, Pekka; Kuisma, Markku; Mackle, Diane; Martin, Daniel; Nolan, Jerry P.; Panwar, Rakshit; Reinikainen, Matti; Skrifvars, Markus B.; Thomas, Matt
Contributor: University of Helsinki, Anestesiologian yksikkö
University of Helsinki, HUS Emergency Medicine and Services
University of Helsinki, HUS Emergency Medicine and Services
Date: 2020-12
Language: eng
Number of pages: 8
Belongs to series: Resuscitation
ISSN: 0300-9572
URI: http://hdl.handle.net/10138/335508
Abstract: Aim: The effect of conservative versus liberal oxygen therapy on mortality rates in post cardiac arrest patients is uncertain. Methods: We undertook an individual patient data meta-analysis of patients randomised in clinical trials to conservative or liberal oxygen therapy after a cardiac arrest. The primary end point was mortality at last follow-up. Results: Individual level patient data were obtained from seven randomised clinical trials with a total of 429 trial participants included. Four trials enrolled patients in the pre-hospital period. Of these, two provided protocol-directed oxygen therapy for 60 min, one provided it until the patient was handed over to the emergency department staff, and one provided it for a total of 72 h or until the patient was extubated. Three trials enrolled patients after intensive care unit (ICU) admission and generally continued protocolised oxygen therapy for a longer period, often until ICU discharge. A total of 90 of 221 patients (40.7%) assigned to conservative oxygen therapy and 103 of 206 patients (50%) assigned to liberal oxygen therapy had died by this last point of followup; absolute difference; odds ratio (OR) adjusted for study only; 0.67; 95% CI 0.45 to 0.99; P = 0.045; adjusted OR, 0.58; 95% CI 0.35 to 0.96; P = 0.04. Conclusion: Conservative oxygen therapy was associated with a statistically significant reduction in mortality at last follow-up compared to liberal oxygen therapy but the certainty of available evidence was low or very low due to bias, imprecision, and indirectness. PROSPERO registration number: CRD42019138931.
Subject: Oxygen therapy
Cardiac arrest
Hypoxic ischaemic encephalopathy
Hyperoxaemia
Hypoxaemia
Randomised controlled trial
Individual patient data meta-analysis
RESUSCITATION
ASSOCIATION
CONSENSUS
CARE
3126 Surgery, anesthesiology, intensive care, radiology
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