Resuscitation. 2025 Dec 4:110917. doi: 10.1016/j.resuscitation.2025.110917. Online ahead of print.
RATIONALE: Arterial blood gas analysis is a key component of the initial assessment for patients with cardiac arrest. In accidental hypothermia, temperature effects on gas solubility and hemoglobin-oxygen affinity confound oxygenation status. It remains unclear whether these values can be used to exclude patients from extracorporeal cardiopulmonary resuscitation in hypothermic cardiac arrest.
AIM: of the study: To determine whether initial arterial oxygenation parameters predict favorable neurological outcomes in patients with hypothermic cardiac arrest treated with extracorporeal cardiopulmonary resuscitation.
METHODS: We conducted a retrospective analysis of data from a national registry of patients with severe accidental hypothermia treated between 2014 and 2025. The study included adult patients with core temperature ≤28°C who underwent extracorporeal cardiopulmonary resuscitation for hypothermic cardiac arrest. Arterial blood samples drawn on arrival, before extracorporeal support, were temperature-corrected using established equations. The primary outcome was survival to hospital discharge with good neurological status (Cerebral Performance Category 1-2). Associations were evaluated with multivariable generalized additive models to allow non-linear effects.
RESULTS: In our cohort of 89 patients, neither arterial oxygen partial pressure nor saturation were independent predictors of a favorable neurological outcome. When corrected for temperature, severe hypoxemia < 50mmHg was present in two-thirds of patients with a good neurological outcome. Conclusions A single arterial blood gas analysis is unreliable for determining prognosis in patients with non-asphyxial hypothermic cardiac arrest. Initial hypoxemia does not preclude a favorable neurological outcome; therefore, oxygenation metrics should not serve as sole exclusion criterion for ECPR in hypothermic cardiac arrest.
PubMed:41352475 | DOI:10.1016/j.resuscitation.2025.110917