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.
