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dc.contributor.authorBray, Janeten_US
dc.contributor.authorHein, Cindyen_US
dc.contributor.authorSmith, Karen Len_US
dc.contributor.authorStephenson, Michaelen_US
dc.contributor.authorGrantham, Hugh Jonathonen_US
dc.contributor.authorFinn, Judithen_US
dc.contributor.authorStub, Dionen_US
dc.contributor.authorCameron, Peter Aen_US
dc.contributor.authorBernard, Stephenen_US
dc.contributor.authorEXACT Investigatorsen_US
dc.date.accessioned2019-02-14T04:05:40Z
dc.date.available2019-02-14T04:05:40Z
dc.date.issued2018-04-21
dc.identifier.citationBray, J. E., Hein, C., Smith, K., Stephenson, M., Grantham, H., Finn, J., … Bernard, S. (2018). Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial). Resuscitation, 128, 211–215. https://doi.org/10.1016/j.resuscitation.2018.04.019en_US
dc.identifier.issn0300-9572
dc.identifier.urihttp://hdl.handle.net/2328/38954
dc.description© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (April 2018) in accordance with the publisher’s archiving policyen_US
dc.description.abstractIntroduction Recent studies suggest the administration of 100% oxygen to hyperoxic levels following return-of-spontaneous-circulation (ROSC) post-cardiac arrest may be harmful. However, the feasibility and safety of oxygen titration in the prehospital setting is unknown. We conducted a multi-centre, phase-2 study testing whether prehospital titration of oxygen results in an equivalent number of patients arriving at hospital with oxygen saturations SpO2 ≥ 94%. Methods We enrolled unconscious adults with: sustained ROSC; initial shockable rhythm; an advanced airway; and an SpO2 ≥ 95%. Initially (Sept 2015–March 2016) patients were randomised 1:1 to either 2 L/minute (L/min) oxygen (titrated) or >10 L/min oxygen (control) via a bag-valve reservoir. However, one site experienced a high number of desaturations (SpO2 < 94%) in the titrated arm and this arm was changed (April 2016) to an initial reduction of oxygen to 4 L/min then, if tolerated, to 2 L/min, and the desaturation limit was decreased to <90%. Results We randomised 61 patients to titrated (n = 37: 2L/min = 20 and 2–4 L/min = 17) oxygen or control (n = 24). Patients allocated to titrated oxygen were more likely to desaturate compared to controls ((SpO2 < 94%: 43% vs. 4%, p = 0.001; SpO2 < 90%: 19% vs. 4%, p = 0.09). The majority of desaturations (81%) occurred at 2L/min. On arrival at hospital the majority of patients had a SpO2 ≥ 94% (titrated: 90% vs. control: 100%) and all patients had a SpO2 ≥ 90%. One patient (control) re-arrested. Survival to hospital discharge was similar. Conclusion Oxygen titration post-ROSC is feasible in the prehospital environment, but incremental titration commencing at 4L/min oxygen flow may be needed to maintain an oxygen saturation >90% (NCT02499042).en_US
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.rights© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:http://creativecommons.org/licenses/by-nc-nd/4.0/en_US
dc.subjectoxygen,en_US
dc.subjecthyperoxiaen_US
dc.subjectout-of-hospital cardiac arresten_US
dc.subjectheart arresten_US
dc.subjectpost-resuscitation careen_US
dc.titleOxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial)en_US
dc.typeArticleen_US
dc.identifier.doihttps://doi.org/10.1016/j.resuscitation.2018.04.019en_US
dc.rights.holderElsevier.en_US
dc.rights.licenseCC-BY-NC-ND
local.contributor.authorOrcidLookupBray, Janet: https://orcid.org/0000-0002-1559-5882en_US
local.contributor.authorOrcidLookupSmith, Karen L: https://orcid.org/0000-0002-9057-0685en_US
local.contributor.authorOrcidLookupStub, Dion: https://orcid.org/0000-0001-8686-2709en_US


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