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PaCO2 and the Post-Arrest Patient
- Alterations in PaCO2 are common during the post-arrest period and have been associated with worse patient centered outcomes.
- Hypercarbia can dilate cerebral vessels, increase cerebral blood flow, and may increase intracranial pressure.
- Conversely, hypocarbia can constrict cerebral vessels and may reduce cerebral blood flow.
- Though the current evidence is primarily limited to observational trials, a recent meta-analysis found that "normocarbia" was associated with improved hospital survival and neurologic outcome.
- Take Home: Adjust mechanical ventilation to target normocarbia (PaCO2 or ETCO2) in the post-arrest patient.
References
McKenzie N, et al. A systematic review and meta-analysis of the association between arterial carbon dioxide tension and outcomes after cardiac arrest. Resuscitation 2017; 111:116-126.