PDF(Pubmed)
Abstract：
Therapeutic hypercapnia has been proposed as a potential strategy to enhance cerebral perfusion and improve outcomes in patients after cardiac arrest. However, the effects of targeted hypercapnia remain unclear. We conducted a systematic review and meta-analysis to evaluate the impact of hypercapnia compared to normocapnia on mortality and length of stay in post-cardiac arrest patients. We searched major databases for randomized controlled trials and observational studies comparing outcomes between hypercapnia and normocapnia in adult post-cardiac arrest patients. Data on in-hospital mortality and the ICU and hospital length of stay were extracted and pooled using random-effects meta-analysis. Five studies (two randomized controlled trials (RCTs) and three observational studies) with a total of 1,837 patients were included. Pooled analysis showed hypercapnia was associated with significantly higher in-hospital mortality compared to normocapnia (56.2% vs. 50.5%, OR 1.24, 95% CI 1.12-1.37, p<0.001). There was no significant heterogeneity (I2 = 25%, p = 0.26). No statistically significant differences were found for ICU length of stay (mean difference 0.72 days, 95% CI -0.51 to 1.95) or hospital length of stay (mean difference 1.13 days, 95% CI -0.67 to 2.93) between the groups. Sensitivity analysis restricted to mild hypercapnia studies did not alter the mortality findings. This meta-analysis did not find a mortality benefit with targeted hypercapnia compared to normocapnia in post-cardiac arrest patients. The results align with current guidelines recommending a normal partial pressure of arterial carbon dioxide (PaCO2) target range and do not support routinely targeting higher carbon dioxide levels in this setting.
摘要：
已提出治疗性高碳酸血症作为增强心脏骤停后患者的脑灌注和改善预后的潜在策略。然而,靶向性高碳酸血症的影响尚不清楚.我们进行了系统评价和荟萃分析，以评估高碳酸血症与正常碳酸血症对心脏骤停后患者死亡率和住院时间的影响。我们在主要数据库中搜索了随机对照试验和观察性研究，比较了成人心脏骤停后高碳酸血症和正常碳酸血症的结局。使用随机效应荟萃分析提取并汇总住院死亡率，ICU和住院时间的数据。纳入5项研究（2项随机对照试验（RCT）和3项观察性研究），共1,837例患者。汇总分析显示，与正常碳酸血症相比，高碳酸血症与住院死亡率显着升高相关（56.2％vs.50.5%,OR1.24，95%CI1.12-1.37，p<0.001)。没有显著的异质性(I2=25%，p=0.26）。ICU住院时间无统计学差异（平均差异0.72天，95%CI-0.51至1.95)或住院时间(平均差异1.13天，组间95%CI-0.67至2.93)。仅限于轻度高碳酸血症研究的敏感性分析并未改变死亡率结果。这项荟萃分析没有发现与正常碳酸血症相比，心脏骤停后患者有针对性的高碳酸血症的死亡率获益。结果与当前指南建议的正常动脉二氧化碳分压（PaCO2）目标范围一致，并且不支持在这种情况下常规针对更高的二氧化碳水平。
