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BOX RCT – What’s the Right PaO2 Goal for OHCA Patients?

October 13, 2022

Written by Clay Smith

Spoon Feed
There was no difference in death or discharge with profound disability in patients with high or low PaO2 targets.

Why does this matter?
Yesterday we covered MAP targets post-OHCA. In this same multifactorial RCT, they randomized to low or high PaO2 targets. The literature has been mixed for oxygenation targets: too high is bad, and too low is bad; the ideal range is probably 94-98%. Does this make a difference in OHCA patients?

Not the magic bullet
789 comatose patients after OHCA were randomized to either high or low MAP goal (covered yesterday) or high or low PaO2 goal: 68-75 mm Hg or 98-105 mm Hg based on serial ABGs drawn from an arterial line. All patients had strict temperature control at 36°C. There was no difference in the composite primary outcome of all-cause mortality or discharge with profound disability (CPC score 3-4): 32% in the low PaO2 group and 33.9% in the high PaO2 group, HR 0.95 (95%CI 0.75 to 1.21). Apart from the basics of neuroprotective care discussed yesterday, high MAP or low PaO2 goals don’t play a major role in helping OHCA patients recover.

Oxygen Targets in Comatose Survivors of Cardiac Arrest. N Engl J Med. 2022 Aug 27. doi: 10.1056/NEJMoa2208686. Online ahead of print.