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Letter by Bellomo et al Regarding <strong>Article</strong>, ''Relationship Between Supranormal Oxygen<br />

Tension and Outcome After Resuscitation From Cardiac Arrest''<br />

Rinaldo Bellomo, Michael Bailey and Alistair Nichol<br />

Circulation. 2012;125:e288<br />

doi: 10.1161/CIRCULATIONAHA.111.053611<br />

Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231<br />

Copyright © 2012 American Heart Association, Inc. All rights reserved.<br />

Print ISSN: 0009-7322. Online ISSN: 1524-4539<br />

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http://circ.ahajournals.org/content/125/3/e288<br />

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Correspondence<br />

Letter by Bellomo et al Regarding <strong>Article</strong>,<br />

“Relationship Between Supranormal Oxygen<br />

Tension and Outcome After Resuscitation From<br />

Cardiac Arrest”<br />

To the Editor:<br />

We read the paper by Kilgannon and colleagues 1 with interest. In<br />

a recent study involving 12 108 intensive care unit survivors of<br />

cardiac arrest in Australia and New Zealand, 2 we found that the<br />

relationship between hyperoxia and mortality was significantly<br />

altered by the introduction of FIO 2 into the predictive multivariable<br />

model such that PaO 2 was no longer associated with hospital<br />

mortality. Such findings and clinical experience suggest that a high<br />

PaO 2 may thus simply reflect a high FIO 2 . A high FIO 2 would, in turn,<br />

reflect a clinical attempt to compensate for greater physiological<br />

instability. If this were the case, the relationship between higher PaO 2<br />

and greater mortality would simply represent the fact that PaO 2 is a<br />

marker of illness severity instead of a mediator of injury. Accordingly,<br />

we think that the authors should report their analysis after<br />

correction for FIO 2 . Similarly, we found that the APACHE III (Acute<br />

Physiology and Chronic Health Evaluation III) score also significantly<br />

decreased the associated between PaO 2 and mortality. Given<br />

such findings in a large cohort, we similarly suggest that adjustment<br />

for APACHE III score is crucial to any analysis of the relationship<br />

between PaO 2 and mortality. We have checked with colleagues in the<br />

<strong>Unit</strong>ed States, and they have confirmed that such information is<br />

recorded and stored as part of the Project IMPACT database; thus, it<br />

should be available to the investigators. Finally, it would be<br />

important to report how representative of early intervention and<br />

mean oxygenation the PaO 2 values used in the study might have<br />

been. Accordingly, we think the authors should also report how<br />

many blood gas samples were obtained on average in the first 24<br />

hours, as well as the mean time between admission to the intensive<br />

care unit and the peak PaO 2 in their cohort. Such information seems<br />

vital to ensuring that the reported association is scientifically robust.<br />

None.<br />

Disclosures<br />

Rinaldo Bellomo, MD<br />

Michael Bailey, PhD<br />

Alistair Nichol, PhD<br />

Australian and New Zealand <strong>Intensive</strong> <strong>Care</strong> Research Centre<br />

School of Public Health and Preventive Medicine<br />

Monash University<br />

Melbourne, Australia<br />

References<br />

1. Kilgannon JH, Jones AE, Parrillo JE, Dellinger P, Milcarek B, Hunter K,<br />

Shapiro NI, Trzeciak S; Emergency Medicine Shock Research Network<br />

(EMShockNet) Investigators. Relationship between supranormal oxygen<br />

tension and outcome after resuscitation from cardiac arrest. Circulation.<br />

2011;123:2717–2722.<br />

2. Bellomo R, Bailey M, Eastwood GM, Nichol A, Pilcher D, Hart GK,<br />

Reade MC, Egi M, Cooper DJ; Study of Oxygen in Critical <strong>Care</strong> (SOCC)<br />

Group. Arterial hyperoxia and in-hospital mortality after resuscitation<br />

from cardiac arrest. Crit <strong>Care</strong>. 2011;15:R90.<br />

(Circulation. 2012;125:e288.)<br />

© 2012 American Heart Association, Inc.<br />

Circulation is available at http://circ.ahajournals.org<br />

DOI: 10.1161/CIRCULATIONAHA.111.053611<br />

Downloaded from http://circ.ahajournals.org/ e288 at Ian Potter Library on April 16, 2013

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