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Record W4380730782 · doi:10.1056/nejmoa2214552

Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest

2023· article· en· W4380730782 on OpenAlexafffund
Glenn M. Eastwood, Alistair Nichol, Carol Hodgson, Rachael Parke, Shay McGuinness, Niklas Nielsen, Stephen Bernard, Markus B. Skrifvars, Dion Stub, Fabio Silvio Taccone, John S. Archer, Demetrios J. Kutsogiannis, Josef Dankiewicz, Gisela Lilja, Tobias Cronberg, Hans Kirkegaard, Gilles Capellier, Giovanni Landoni, Janneke Horn, Theresa M. Olasveengen, Yaseen M. Arabi, Yew Woon Chia, Andrej Markota, Matthias Hænggi, Matt P. Wise, Anders Morten Grejs, Steffen Christensen, Heidi Munk-Andersen, Asger Granfeldt, Geir Øystein Andersen, Eirik Qvigstad, Arnljot Flaa, Matthew Thomas, Katie Sweet, Jeremy Bewley, Minna Bäcklund, Marjaana Tiainen, Manuela Iten, Anja Levis, Leah Peck, James Walsham, Adam M. Deane, Angaj Ghosh, Filippo Annoni, Yan Chen, David Knight, Eden Lesona, Haytham Tlayjeh, Franc Svenšek, Peter J. McGuigan, Jade Cole, David Pogson, Matthias P. Hilty, Joachim Düring, Michael Bailey, Eldho Paul, Bridget Ady, Kate Ainscough, Anna Hunt, Sinéad Monahan, Tony Trapani, Ciara Fahey, Rinaldo Bellomo

Bibliographic record

VenueNew England Journal of Medicine · 2023
Typearticle
Languageen
FieldMedicine
TopicCardiac Arrest and Resuscitation
Canadian institutionsUniversity of Alberta Hospital
FundersHealth Research Council of New ZealandNational Health and Medical Research CouncilQueen's UniversityUniversity of BernHealth Research BoardInselspital, Universitätsspital BernQueen's University Belfast
KeywordsNormocapniaHypercapniaMedicineAnesthesiaCardiologyEmergency medicineInternal medicineAcidosis

Abstract

fetched live from OpenAlex

Guidelines recommend normocapnia for adults with coma who are resuscitated after out-of-hospital cardiac arrest. However, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes. Download a PDF of the Research Summary. We randomly assigned adults with coma who had been resuscitated after out-of-hospital cardiac arrest of presumed cardiac or unknown cause and admitted to the intensive care unit (ICU) in a 1:1 ratio to either 24 hours of mild hypercapnia (target partial pressure of arterial carbon dioxide [Paco2], 50 to 55 mm Hg) or normocapnia (target Paco2, 35 to 45 mm Hg). The primary outcome was a favorable neurologic outcome, defined as a score of 5 (indicating lower moderate disability) or higher, as assessed with the use of the Glasgow Outcome Scale–Extended (range, 1 [death] to 8, with higher scores indicating better neurologic outcome) at 6 months. Secondary outcomes included death within 6 months. A total of 1700 patients from 63 ICUs in 17 countries were recruited, with 847 patients assigned to targeted mild hypercapnia and 853 to targeted normocapnia. A favorable neurologic outcome at 6 months occurred in 332 of 764 patients (43.5%) in the mild hypercapnia group and in 350 of 784 (44.6%) in the normocapnia group (relative risk, 0.98; 95% confidence interval [CI], 0.87 to 1.11; P=0.76). Death within 6 months after randomization occurred in 393 of 816 patients (48.2%) in the mild hypercapnia group and in 382 of 832 (45.9%) in the normocapnia group (relative risk, 1.05; 95% CI, 0.94 to 1.16). The incidence of adverse events did not differ significantly between groups. In patients with coma who were resuscitated after out-of-hospital cardiac arrest, targeted mild hypercapnia did not lead to better neurologic outcomes at 6 months than targeted normocapnia. (Funded by the National Health and Medical Research Council of Australia and others; TAME ClinicalTrials.gov number, NCT03114033.) QUICK TAKE VIDEO SUMMARYMild Hypercapnia after Out-of-Hospital Cardiac Arrest 02:19

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How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.001
metaresearch head score (Gemma)0.001
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: none
GenreCandidate signal: Empirical · Consensus signal: Empirical
Teacher disagreement score0.253
Threshold uncertainty score0.409

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0010.001
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0010.000
Bibliometrics0.0000.000
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0000.000
Insufficient payload (model declined to judge)0.0000.000

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.018
GPT teacher head0.287
Teacher spread0.268 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designNot applicable
Domainnot available
GenreEmpirical

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations135
Published2023
Admission routes2
Has abstractyes

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