1. SUMMARY What are the optimal paO2 and paCO2 targets during and after cardiac arrest?
SSAI Malmö
MD, PhD, FCICM, EDIC Markus Skrifvars
Departement of Anaesthesiology, Intensive Care and Paine medicine
Helsinki University Hospital, Finland

2. Key points – Oxygenation during CPR
Experimental evidence suggests that effective chest compressions are the most important determinant of brain tissue oxygenation
Ventilation with 100% oxygen during CPR may be associated with hyperoxia especially after return of sponaneous circulation but its clinical implications are unknown
The risk of extreme hyperoxia is likely to be more common with short delay to start of CPR
The use of 100% oxygen is likely more relevant with hypoxic arrests that with arrests with a cardiac etiology
Intra-arrest hyperventilation is detrimental and should be avoided

3. Key points – Immediately after ROSC
After ROSC the circulation is commonly hyperdynamic partly due to the use of adrenaline
After ROSC aim to titrate oxygen use
Continue giving 100% oxygen only with verified hypoxia
Titrate ventilation according to paCO2
Monitoring oxygenation and ventilation require arterial blood gas analysis, peripheral 02 saturation monitoring can be inexact

4. Key points – During care in the ICU
During the following hours (4-48 hours) there appears to be a decrease in blood flow with an increase in oxygen extraction in the brain
Carbon dioxide is an important determinant of blood flow
Moderate hypercapnia may be protective
Hypoxia and hypocapnia is harmful and should be avoided
During TTM hyperventilation is common, patients may require much less ventilation than anticipated
Trials are beginning looking at the value of moderate hypercapnia