PURPOSE: The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. METHODS: Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. RESULTS: A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (VT) was 7 (Interquartile range, IQR = 6.2-8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5-9) cmH20, plateau pressure was 20 cmH20 (IQR = 17-23), driving pressure was 12 cmH20 (IQR = 10-15), mechanical power 16.2 J/min (IQR = 12.1-21.8), ventilatory ratio was 1.27 (IQR = 1.04-1.6), and respiratory rate was 17 breaths/minute (IQR = 14-20). Median partial pressure of oxygen was 87 mmHg (IQR = 75-105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36-45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003-1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001-1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. CONCLUSIONS: Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes.

Anesthesia and Critical Care San Martino Policlinico Hospital IRCCS for Oncology and Neuroscience Genoa Italy

Australian and New Zealand Intensive Care Research Centre Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia

Copenhagen Trial Unit Centre for Clinical Intervention Research Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Anaesthesia and Intensive Care Biomedical and Clinical Sciences Linköping University Linköping Sweden

Department of Anaesthesiology and Intensive Care Medicine Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg 423 45 Gothenburg Sweden

Department of Anesthesiology and Surgical Trauma Intensive Care Hospital Clínic Universitari de Valencia Valencia Spain

Department of Clinical Medicine Anaesthesiology and Intensive Care Lund University Lund Sweden

Department of Clinical Sciences Lund Anaesthesia and Intensive Care and Clinical Sciences Helsingborg Helsingborg Hospital Lund University Lund Sweden

Department of Clinical Sciences Lund Anesthesia and Intensive Care Lund University Lund Sweden

Department of Clinical Sciences Lund Cardiology Skåne University Hospital Lund University Lund Sweden

Department of Clinical Sciences Lund Neurology Skåne University Hospital Lund University Getingevägen 4 222 41 Lund Sweden

Department of Clinical Sciences Malmö Lund University Malmö Sweden

Department of Critical Care University of Melbourne Parkville VIC Australia

Department of Intensive Care Austin Hospital Melbourne Australia

Department of Intensive Care Medicine Université Libre de Bruxelles Hopital Erasme Brussels Belgium

Department of Internal Medicine Cardioangiology University Hospital Hradec Králové Hradec Králové Czech Republic

Department of Internal Medicine Faculty of Medicine in Hradec Králové Charles University Hradec Králové Czech Republic

Department of Medicine Centre for Resuscitation Science Karolinska Institutet Södersjukhuset Sjukhusbacken 10 Solna 118 83 Stockholm Sweden

Department of Medicine University of Barcelona Barcelona Spain

Department of Operation and Intensive Care Lund University Hallands Hospital Halmstad Halland Sweden

Department of Regional Health Research Faculty of Health Sciences University of Southern Denmark Odense Denmark

Department of Surgery University of Valencia Valencia Spain

Department of Surgical Sciences and Integrated Diagnostics University of Genoa Viale Benedetto XV 16 Genoa Italy

Division of Intensive Care and Emergency Medicine Department of Internal Medicine Medical University Innsbruck Innsbruck Austria

Institute of Intensive Care Medicine University Hospital Zurich Rämistrasse 100 8091 Zurich Switzerland

Intensive Care Unit St George Hospital Sydney Australia

Intensive Care Unit Wellington Regional Hospital Wellington New Zealand

Malcolm Fisher Department of Intensive Care Royal North Shore Hospital Critical Care Division The George Institute for Global Health Faculty of Medicine UNSW Sydney Sydney Australia

Medical Research Institute of New Zealand Private Bag 7902 Wellington 6242 New Zealand

Monash University Melbourne VIC Australia

University Hospitals Bristol NHS Foundation Trust Bristol UK

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Intensive Care Med. 2022 Aug;48(8):1056-1058. doi: 10.1007/s00134-022-06779-x. PubMed

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Intensive Care Med. 2022 Dec;48(12):1827-1828. doi: 10.1007/s00134-022-06878-9. PubMed

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Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial

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