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    Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge among Patients Resuscitated after Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial

    Access Status
    Open access via publisher
    Authors
    Bernard, S.A.
    Bray, Janet
    Smith, K.
    Stephenson, M.
    Finn, Judith
    Grantham, H.
    Hein, C.
    Masters, S.
    Stub, D.
    Perkins, G.D.
    Dodge, N.
    Martin, C.
    Hopkins, S.
    Cameron, P.
    Date
    2022
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Bernard, S.A. and Bray, J.E. and Smith, K. and Stephenson, M. and Finn, J. and Grantham, H. and Hein, C. et al. 2022. Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge among Patients Resuscitated after Out-of-Hospital Cardiac Arrest: The EXACT Randomized Clinical Trial. JAMA. 328 (18): pp. 1818-1826.
    Source Title
    JAMA
    DOI
    10.1001/jama.2022.17701
    ISSN
    0098-7484
    Faculty
    Faculty of Health Sciences
    School
    Curtin School of Nursing
    Funding and Sponsorship
    http://purl.org/au-research/grants/nhmrc/1107509
    http://purl.org/au-research/grants/nhmrc/116453
    http://purl.org/au-research/grants/nhmrc/1174838
    http://purl.org/au-research/grants/nhmrc/1139686
    URI
    http://hdl.handle.net/20.500.11937/93113
    Collection
    • Curtin Research Publications
    Abstract

    Importance: The administration of a high fraction of oxygen following return of spontaneous circulation in out-of-hospital cardiac arrest may increase reperfusion brain injury. Objective: To determine whether targeting a lower oxygen saturation in the early phase of postresuscitation care for out-of-hospital cardiac arrest improves survival at hospital discharge. Design, Setting, and Participants: This multicenter, parallel-group, randomized clinical trial included unconscious adults with return of spontaneous circulation and a peripheral oxygen saturation (Spo2) of at least 95% while receiving 100% oxygen. The trial was conducted in 2 emergency medical services and 15 hospitals in Victoria and South Australia, Australia, between December 11, 2017, and August 11, 2020, with data collection from ambulance and hospital medical records (final follow-up date, August 25, 2021). The trial enrolled 428 of a planned 1416 patients. Interventions: Patients were randomized by paramedics to receive oxygen titration to achieve an oxygen saturation of either 90% to 94% (intervention; n = 216) or 98% to 100% (standard care; n = 212) until arrival in the intensive care unit. Main Outcomes and Measures: The primary outcome was survival to hospital discharge. There were 9 secondary outcomes collected, including hypoxic episodes (Spo2<90%) and prespecified serious adverse events, which included hypoxia with rearrest. Results: The trial was stopped early due to the COVID-19 pandemic. Of the 428 patients who were randomized, 425 were included in the primary analysis (median age, 65.5 years; 100 [23.5%] women) and all completed the trial. Overall, 82 of 214 patients (38.3%) in the intervention group survived to hospital discharge compared with 101 of 211 (47.9%) in the standard care group (difference, -9.6% [95% CI, -18.9% to -0.2%]; unadjusted odds ratio, 0.68 [95% CI, 0.46-1.00]; P =.05). Of the 9 prespecified secondary outcomes collected during hospital stay, 8 showed no significant difference. A hypoxic episode prior to intensive care was observed in 31.3% (n = 67) of participants in the intervention group and 16.1% (n = 34) in the standard care group (difference, 15.2% [95% CI, 7.2%-23.1%]; OR, 2.37 [95% CI, 1.49-3.79]; P <.001). Conclusions and Relevance: Among patients achieving return of spontaneous circulation after out-of-hospital cardiac arrest, targeting an oxygen saturation of 90% to 94%, compared with 98% to 100%, until admission to the intensive care unit did not significantly improve survival to hospital discharge. Although the trial is limited by early termination due to the COVID-19 pandemic, the findings do not support use of an oxygen saturation target of 90% to 94% in the out-of-hospital setting after resuscitation from cardiac arrest. Trial Registration: ClinicalTrials.gov Identifier: NCT03138005.

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