This retrospective MIMIC-IV cohort studied first-day hypoxemia and hypocapnia burdens in adult cardiac-arrest ICU patients who survived 24 hours. Among 1,028 patients, 487 (47.4%) died within 28 days of ICU admission. Joint-model adjusted mortality odds ratios were 1.71 (95% CI 1.20–2.45) per 10 mmHg higher hypoxemia burden and 1.88 (95% CI 1.42–2.47) per 5 mmHg higher hypocapnia burden. Hypocapnia showed nonlinearity; categorical analyses found lower mortality odds with low exposure than no exposure for both burdens, while high hypoxemia exposure was associated with higher odds.
Early hypoxemia and hypocapnia burdens were associated with 28-day mortality among cardiac-arrest patients surviving the first ICU day. Nonlinear and categorical findings complicate interpretation and warrant prospective validation.
Study limitation: Retrospective associations cannot establish causality, and excluding patients who died within 24 hours limits applicability to early deaths.
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