{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:47:53Z","timestamp":1792788473802,"version":"4.5.0"},"reference-count":67,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"National Research Council of Thailand","award":["Distinguished Research Professor Grant"],"award-info":[{"award-number":["Distinguished Research Professor Grant"]}],"id":[{"id":"https:\/\/ror.org\/018wfhg78","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002842","name":"Chiang Mai University","doi-asserted-by":"publisher","award":["Center of Excellence Award"],"award-info":[{"award-number":["Center of Excellence Award"]}],"id":[{"id":"10.13039\/501100002842","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["ICMx"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Post-cardiac arrest care remains challenging, with persistently poor neurological and survival outcomes. Accordingly, novel adjunctive interventions are needed. While maintaining normocapnia is the current standard, hypercapnia has been proposed as a potential intervention. However, its role and potential benefits remain unclear. This comprehensive review summarizes current evidence on the use of hypercapnia in post-cardiac arrest care, focusing on neurological, cardiovascular, and survival outcomes, underlying mechanisms, and directions for future clinical investigations. Observational studies have sparked interest in the potential benefits of hypercapnia during the post-cardiac arrest period, including in specific populations. Methodological variations and conflicting findings from earlier studies have prompted the conduct of controlled trials and animal experiments to clarify its effects. Mild hypercapnia appears to be a practical and clinically safe approach, improving cerebral oxygenation without major adverse events. However, no improvement in long-term neurological recovery or survival has been demonstrated. Moreover, the effects on the cardiovascular and other organ systems, as well as mechanisms at the cellular level, remain inconclusive. Although mild hypercapnia may be considered part of a comprehensive post-cardiac arrest care strategy, further studies are needed to define its optimal application, potential synergy with other interventions, the populations most likely to benefit, and its underlying mechanisms.<\/jats:p>","DOI":"10.1186\/s40635-026-00974-6","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T09:04:04Z","timestamp":1789722244000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Therapeutic hypercapnia after cardiac arrest: still promising or time to move on?"],"prefix":"10.1186","volume":"14","author":[{"given":"Wiput","family":"Laosuksri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borwon","family":"Wittayachamnankul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siriporn C.","family":"Chattipakorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3026-718X","authenticated-orcid":false,"given":"Nipon","family":"Chattipakorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"issue":"1","key":"974_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-017-1670-9","volume":"21","author":"MS Sekhon","year":"2017","unstructured":"Sekhon MS, Ainslie PN, Griesdale DE (2017) Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a \u201ctwo-hit\u201d model. Crit Care 21(1):90. https:\/\/doi.org\/10.1186\/s13054-017-1670-9","journal-title":"Crit Care"},{"issue":"Suppl 1","key":"974_CR2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2025.110733","volume":"215","author":"E Baldi","year":"2025","unstructured":"Baldi E, Wnent J, Caputo ML, Haywood KL, Lilja G, Masterson S et al (2025) European Resuscitation Council guidelines 2025 epidemiology in resuscitation. Resuscitation 215(Suppl 1):110733. https:\/\/doi.org\/10.1016\/j.resuscitation.2025.110733","journal-title":"Resuscitation"},{"issue":"16_suppl_2","key":"974_CR3","doi-asserted-by":"publisher","first-page":"S284","DOI":"10.1161\/CIR.0000000000001372","volume":"152","author":"M Del Rios","year":"2025","unstructured":"Del Rios M, Bartos JA, Panchal AR, Atkins DL, Cabanas JG, Cao D et al (2025) Part 1: Executive summary: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 152(16_suppl_2):S284\u2013S312. https:\/\/doi.org\/10.1161\/CIR.0000000000001372","journal-title":"Circulation"},{"issue":"Suppl 1","key":"974_CR4","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2025.110809","volume":"215","author":"JP Nolan","year":"2025","unstructured":"Nolan JP, Sandroni C, Cariou A, Cronberg T, D\u2019Arrigo S, Haywood K et al (2025) European resuscitation council and european society of intensive care medicine guidelines 2025 post-resuscitation care. Resuscitation 215(Suppl 1):110809. https:\/\/doi.org\/10.1016\/j.resuscitation.2025.110809","journal-title":"Resuscitation"},{"issue":"16_suppl_2","key":"974_CR5","doi-asserted-by":"publisher","first-page":"S673","DOI":"10.1161\/CIR.0000000000001375","volume":"152","author":"KG Hirsch","year":"2025","unstructured":"Hirsch KG, Amorim E, Coppler PJ, Drennan IR, Elliott A, Gordon AJ et al (2025) Part 11: Post-cardiac arrest care: 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 152(16_suppl_2):S673\u2013S718","journal-title":"Circulation"},{"key":"974_CR6","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12010259","author":"T Lazzarin","year":"2022","unstructured":"Lazzarin T, Tonon CR, Martins D, Favero EL Jr., Baumgratz TD, Pereira FWL et al (2022) Post-cardiac arrest: mechanisms, management, and future perspectives. J Clin Med. https:\/\/doi.org\/10.3390\/jcm12010259","journal-title":"J Clin Med"},{"issue":"1","key":"974_CR7","doi-asserted-by":"publisher","first-page":"25539","DOI":"10.1038\/s41598-024-76979-6","volume":"14","author":"J Hu","year":"2024","unstructured":"Hu J, Ai M, Xie S, Qian Z, Zhang L, Huang L (2024) NSE and S100beta as serum alarmins in predicting neurological outcomes after cardiac arrest. Sci Rep 14(1):25539. https:\/\/doi.org\/10.1038\/s41598-024-76979-6","journal-title":"Sci Rep"},{"issue":"2","key":"974_CR8","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1186\/cc8926","volume":"14","author":"G Curley","year":"2010","unstructured":"Curley G, Laffey JG, Kavanagh BP (2010) Bench-to-bedside review: carbon dioxide. Crit Care 14(2):220. https:\/\/doi.org\/10.1186\/cc8926","journal-title":"Crit Care"},{"key":"974_CR9","doi-asserted-by":"publisher","DOI":"10.3390\/medicina60091381","author":"R Petrovcic","year":"2024","unstructured":"Petrovcic R, Rakusa M, Markota A (2024) Monitoring of cerebral blood flow autoregulation after cardiac arrest. Medicina (Kaunas). https:\/\/doi.org\/10.3390\/medicina60091381","journal-title":"Medicina (Kaunas)"},{"issue":"3","key":"974_CR10","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1097\/MCC.0000000000000084","volume":"20","author":"GM Eastwood","year":"2014","unstructured":"Eastwood GM, Young PJ, Bellomo R (2014) The impact of oxygen and carbon dioxide management on outcome after cardiac arrest. Curr Opin Crit Care 20(3):266\u2013272. https:\/\/doi.org\/10.1097\/MCC.0000000000000084","journal-title":"Curr Opin Crit Care"},{"issue":"7","key":"974_CR11","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1016\/j.resuscitation.2013.02.014","volume":"84","author":"AG Schneider","year":"2013","unstructured":"Schneider AG, Eastwood GM, Bellomo R, Bailey M, Lipcsey M, Pilcher D et al (2013) Arterial carbon dioxide tension and outcome in patients admitted to the intensive care unit after cardiac arrest. Resuscitation 84(7):927\u2013934. https:\/\/doi.org\/10.1016\/j.resuscitation.2013.02.014","journal-title":"Resuscitation"},{"issue":"6","key":"974_CR12","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1097\/CCM.0000000000000228","volume":"42","author":"J Vaahersalo","year":"2014","unstructured":"Vaahersalo J, Bendel S, Reinikainen M, Kurola J, Tiainen M, Raj R et al (2014) Arterial blood gas tensions after resuscitation from out-of-hospital cardiac arrest: associations with long-term neurologic outcome. Crit Care Med 42(6):1463\u20131470. https:\/\/doi.org\/10.1097\/CCM.0000000000000228","journal-title":"Crit Care Med"},{"issue":"2","key":"974_CR13","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1097\/ALN.0b013e3181ca8257","volume":"112","author":"Q Zhou","year":"2010","unstructured":"Zhou Q, Cao B, Niu L, Cui X, Yu H, Liu J et al (2010) Effects of permissive hypercapnia on transient global cerebral ischemia-reperfusion injury in rats. Anesthesiology 112(2):288\u2013297. https:\/\/doi.org\/10.1097\/ALN.0b013e3181ca8257","journal-title":"Anesthesiology"},{"issue":"21","key":"974_CR14","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.027685","volume":"11","author":"CH Wang","year":"2022","unstructured":"Wang CH, Huang CH, Tsai MS, Wang CC, Chang WT, Liu SH et al (2022) Inhaled carbon dioxide improves neurological outcomes by downregulating hippocampal autophagy and apoptosis in an asphyxia-induced cardiac arrest and resuscitation rat model. J Am Heart Assoc 11(21):e027685. https:\/\/doi.org\/10.1161\/JAHA.122.027685","journal-title":"J Am Heart Assoc"},{"key":"974_CR15","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.lfs.2017.03.018","volume":"176","author":"XY Shi","year":"2017","unstructured":"Shi XY, Hu LY, Liu MJ, Zou LP (2017) Hypercapnia-induced brain acidosis: effects and putative mechanisms on acute kainate induced seizures. Life Sci 176:82\u201387. https:\/\/doi.org\/10.1016\/j.lfs.2017.03.018","journal-title":"Life Sci"},{"issue":"7","key":"974_CR16","doi-asserted-by":"publisher","first-page":"173","DOI":"10.3238\/arztebl.m2025.0006","volume":"122","author":"SK Zumbrunn","year":"2025","unstructured":"Zumbrunn SK, Blatter R, Bissmann B, Amacher SA, Sutter R, Hunziker S (2025) The prognosis after cardiac arrest: evidence on the short- and long-term course. Dtsch Arztebl Int 122(7):173\u2013179. https:\/\/doi.org\/10.3238\/arztebl.m2025.0006","journal-title":"Dtsch Arztebl Int"},{"issue":"1","key":"974_CR17","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s13049-020-00760-7","volume":"28","author":"F Ebner","year":"2020","unstructured":"Ebner F, Riker RR, Haxhija Z, Seder DB, May TL, Ullen S et al (2020) The association of partial pressures of oxygen and carbon dioxide with neurological outcome after out-of-hospital cardiac arrest: an explorative International Cardiac Arrest Registry 2.0 study. Scand J Trauma Resusc Emerg Med 28(1):67. https:\/\/doi.org\/10.1186\/s13049-020-00760-7","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"974_CR18","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.resuscitation.2017.11.033","volume":"123","author":"C Moonen","year":"2018","unstructured":"Moonen C, Lemmens R, Van Paesschen W, Wilmer A, Eertmans W, Ferdinande B et al (2018) The impact of global hemodynamics, oxygen and carbon dioxide on epileptiform EEG activity in comatose survivors of out-of-hospital cardiac arrest. Resuscitation 123:92\u201397. https:\/\/doi.org\/10.1016\/j.resuscitation.2017.11.033","journal-title":"Resuscitation"},{"key":"974_CR19","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.resuscitation.2021.01.035","volume":"162","author":"N McKenzie","year":"2021","unstructured":"McKenzie N, Finn J, Dobb G, Bailey P, Arendts G, Celenza A et al (2021) Arterial carbon dioxide tension has a non-linear association with survival after out-of-hospital cardiac arrest: a multicentre observational study. Resuscitation 162:82\u201390. https:\/\/doi.org\/10.1016\/j.resuscitation.2021.01.035","journal-title":"Resuscitation"},{"key":"974_CR20","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.ajem.2023.01.004","volume":"65","author":"D Zhou","year":"2023","unstructured":"Zhou D, Lv Y, Lin Q, Wang C, Fei S, He W (2023) Association between rate of change in PaCO(2) and functional outcome for patients with hypercapnia after out-of-hospital cardiac arrest: secondary analysis of a randomized clinical trial. Am J Emerg Med 65:139\u2013145. https:\/\/doi.org\/10.1016\/j.ajem.2023.01.004","journal-title":"Am J Emerg Med"},{"issue":"1","key":"974_CR21","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-018-2119-5","volume":"22","author":"F Ebner","year":"2018","unstructured":"Ebner F, Harmon MBA, Aneman A, Cronberg T, Friberg H, Hassager C et al (2018) Carbon dioxide dynamics in relation to neurological outcome in resuscitated out-of-hospital cardiac arrest patients: an exploratory Target Temperature Management Trial substudy. Crit Care 22(1):196. https:\/\/doi.org\/10.1186\/s13054-018-2119-5","journal-title":"Crit Care"},{"key":"974_CR22","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11061523","author":"N Okada","year":"2022","unstructured":"Okada N, Matsuyama T, Okada Y, Okada A, Kandori K, Nakajima S et al (2022) Post-resuscitation partial pressure of arterial carbon dioxide and outcome in patients with out-of-hospital cardiac arrest: a multicenter retrospective cohort study. J Clin Med. https:\/\/doi.org\/10.3390\/jcm11061523","journal-title":"J Clin Med"},{"key":"974_CR23","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1186\/s13054-015-1067-6","volume":"19","author":"HJ Helmerhorst","year":"2015","unstructured":"Helmerhorst HJ, Roos-Blom MJ, van Westerloo DJ, Abu-Hanna A, de Keizer NF, de Jonge E (2015) Associations of arterial carbon dioxide and arterial oxygen concentrations with hospital mortality after resuscitation from cardiac arrest. Crit Care 19:348. https:\/\/doi.org\/10.1186\/s13054-015-1067-6","journal-title":"Crit Care"},{"issue":"3","key":"974_CR24","doi-asserted-by":"publisher","first-page":"134","DOI":"10.4103\/JETS.JETS_146_16","volume":"10","author":"KI von Auenmueller","year":"2017","unstructured":"von Auenmueller KI, Christ M, Sasko BM, Trappe HJ (2017) The value of arterial blood gas parameters for prediction of mortality in survivors of out-of-hospital cardiac arrest. J Emerg Trauma Shock 10(3):134\u2013139. https:\/\/doi.org\/10.4103\/JETS.JETS_146_16","journal-title":"J Emerg Trauma Shock"},{"key":"974_CR25","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.resuscitation.2017.08.244","volume":"120","author":"HE Wang","year":"2017","unstructured":"Wang HE, Prince DK, Drennan IR, Grunau B, Carlbom DJ, Johnson N et al (2017) Post-resuscitation arterial oxygen and carbon dioxide and outcomes after out-of-hospital cardiac arrest. Resuscitation 120:113\u2013118. https:\/\/doi.org\/10.1016\/j.resuscitation.2017.08.244","journal-title":"Resuscitation"},{"issue":"1","key":"974_CR26","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-020-03039-6","volume":"24","author":"PJ McGuigan","year":"2020","unstructured":"McGuigan PJ, Shankar-Hari M, Harrison DA, Laffey JG, McAuley DF (2020) The interaction between arterial oxygenation and carbon dioxide and hospital mortality following out of hospital cardiac arrest: a cohort study. Crit Care 24(1):336. https:\/\/doi.org\/10.1186\/s13054-020-03039-6","journal-title":"Crit Care"},{"key":"974_CR27","doi-asserted-by":"publisher","DOI":"10.3390\/life14030403","author":"R Soloperto","year":"2024","unstructured":"Soloperto R, Magni F, Farinella A, Bogossian EG, Peluso L, De Luca N et al (2024) A comparison of prognostic factors in a large cohort of in-hospital and out-of-hospital cardiac arrest patients. Life (Basel). https:\/\/doi.org\/10.3390\/life14030403","journal-title":"Life (Basel)"},{"issue":"1","key":"974_CR28","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.ajem.2013.09.044","volume":"32","author":"BK Lee","year":"2014","unstructured":"Lee BK, Jeung KW, Lee HY, Lee SJ, Jung YH, Lee WK et al (2014) Association between mean arterial blood gas tension and outcome in cardiac arrest patients treated with therapeutic hypothermia. Am J Emerg Med 32(1):55\u201360. https:\/\/doi.org\/10.1016\/j.ajem.2013.09.044","journal-title":"Am J Emerg Med"},{"issue":"21","key":"974_CR29","doi-asserted-by":"publisher","first-page":"2107","DOI":"10.1161\/CIRCULATIONAHA.112.000168","volume":"127","author":"BW Roberts","year":"2013","unstructured":"Roberts BW, Kilgannon JH, Chansky ME, Mittal N, Wooden J, Trzeciak S (2013) Association between postresuscitation partial pressure of arterial carbon dioxide and neurological outcome in patients with post-cardiac arrest syndrome. Circulation 127(21):2107\u20132113. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.112.000168","journal-title":"Circulation"},{"issue":"1","key":"974_CR30","doi-asserted-by":"publisher","DOI":"10.1186\/2110-5820-4-9","volume":"4","author":"BW Roberts","year":"2014","unstructured":"Roberts BW, Kilgannon JH, Chansky ME, Trzeciak S (2014) Association between initial prescribed minute ventilation and post-resuscitation partial pressure of arterial carbon dioxide in patients with post-cardiac arrest syndrome. Ann Intensive Care 4(1):9. https:\/\/doi.org\/10.1186\/2110-5820-4-9","journal-title":"Ann Intensive Care"},{"key":"974_CR31","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.resuscitation.2018.11.015","volume":"135","author":"J Hope Kilgannon","year":"2019","unstructured":"Hope Kilgannon J, Hunter BR, Puskarich MA, Shea L, Fuller BM, Jones C et al (2019) Partial pressure of arterial carbon dioxide after resuscitation from cardiac arrest and neurological outcome: a prospective multi-center protocol-directed cohort study. Resuscitation 135:212\u2013220. https:\/\/doi.org\/10.1016\/j.resuscitation.2018.11.015","journal-title":"Resuscitation"},{"issue":"2","key":"974_CR32","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1097\/HPC.0000000000000350","volume":"23","author":"N Millet","year":"2024","unstructured":"Millet N, Parnia S, Genchanok Y, Parikh PB, Hou W, Patel JK (2024) Association of arterial carbon dioxide tension following in-hospital cardiac arrest with survival and favorable neurologic outcome. Crit Pathw Cardiol 23(2):106\u2013110. https:\/\/doi.org\/10.1097\/HPC.0000000000000350","journal-title":"Crit Pathw Cardiol"},{"key":"974_CR33","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.resuscitation.2020.01.036","volume":"149","author":"D Zhou","year":"2020","unstructured":"Zhou D, Li Z, Zhang S, Wu L, Li Y, Shi G (2020) Association between mild hypercapnia and hospital mortality in patients admitted to the intensive care unit after cardiac arrest: a retrospective study. Resuscitation 149:30\u201338. https:\/\/doi.org\/10.1016\/j.resuscitation.2020.01.036","journal-title":"Resuscitation"},{"issue":"7","key":"974_CR34","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1001\/jamaneurol.2018.0123","volume":"75","author":"R Tiruvoipati","year":"2018","unstructured":"Tiruvoipati R, Pilcher D, Botha J, Buscher H, Simister R, Bailey M (2018) Association of hypercapnia and hypercapnic acidosis with clinical outcomes in mechanically ventilated patients with cerebral injury. JAMA Neurol 75(7):818\u2013826. https:\/\/doi.org\/10.1001\/jamaneurol.2018.0123","journal-title":"JAMA Neurol"},{"key":"974_CR35","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11144211","author":"S Hong","year":"2022","unstructured":"Hong S, Jang JH, Yang JH, Cho YH, Ahn J, Ryu JA (2022) Optimal arterial blood gas tensions for the prognosis of favorable neurological outcomes in survivors after extracorporeal cardiopulmonary resuscitation. J Clin Med. https:\/\/doi.org\/10.3390\/jcm11144211","journal-title":"J Clin Med"},{"issue":"4","key":"974_CR36","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/j.healun.2022.10.019","volume":"42","author":"BL Shou","year":"2023","unstructured":"Shou BL, Ong CS, Premraj L, Brown P, Tonna JE, Dalton HJ et al (2023) Arterial oxygen and carbon dioxide tension and acute brain injury in extracorporeal cardiopulmonary resuscitation patients: analysis of the extracorporeal life support organization registry. J Heart Lung Transplant 42(4):503\u2013511. https:\/\/doi.org\/10.1016\/j.healun.2022.10.019","journal-title":"J Heart Lung Transplant"},{"key":"974_CR37","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2022.12.009","volume":"182","author":"CN Justice","year":"2023","unstructured":"Justice CN, Halperin HR, Vanden Hoek TL, Geocadin RG (2023) Extracorporeal cardiopulmonary resuscitation (eCPR) and cerebral perfusion: a narrative review. Resuscitation 182:109671. https:\/\/doi.org\/10.1016\/j.resuscitation.2022.12.009","journal-title":"Resuscitation"},{"key":"974_CR38","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.ajem.2021.01.093","volume":"44","author":"D Zhou","year":"2021","unstructured":"Zhou D, Ye Y, Kong Y, Li Z, Shi G, Zhou J (2021) The effect of mild hypercapnia on hospital mortality after cardiac arrest may be modified by chronic obstructive pulmonary disease. Am J Emerg Med 44:78\u201384. https:\/\/doi.org\/10.1016\/j.ajem.2021.01.093","journal-title":"Am J Emerg Med"},{"key":"974_CR39","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.resp.2015.03.001","volume":"216","author":"CS Poon","year":"2015","unstructured":"Poon CS, Tin C, Song G (2015) Submissive hypercapnia: why COPD patients are more prone to CO2 retention than heart failure patients. Respir Physiol Neurobiol 216:86\u201393. https:\/\/doi.org\/10.1016\/j.resp.2015.03.001","journal-title":"Respir Physiol Neurobiol"},{"issue":"6","key":"974_CR40","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1513\/AnnalsATS.202311-948OC","volume":"21","author":"AH Frazier","year":"2024","unstructured":"Frazier AH, Topjian AA, Reeder RW, Morgan RW, Fink EL, Franzon D et al (2024) Association of pediatric postcardiac arrest ventilation and oxygenation with survival outcomes. Ann Am Thorac Soc 21(6):895\u2013906. https:\/\/doi.org\/10.1513\/AnnalsATS.202311-948OC","journal-title":"Ann Am Thorac Soc"},{"issue":"12","key":"974_CR41","doi-asserted-by":"publisher","first-page":"1456","DOI":"10.1016\/j.resuscitation.2012.07.019","volume":"83","author":"J Del Castillo","year":"2012","unstructured":"Del Castillo J, Lopez-Herce J, Matamoros M, Canadas S, Rodriguez-Calvo A, Cechetti C et al (2012) Hyperoxia, hypocapnia and hypercapnia as outcome factors after cardiac arrest in children. Resuscitation 83(12):1456\u20131461. https:\/\/doi.org\/10.1016\/j.resuscitation.2012.07.019","journal-title":"Resuscitation"},{"issue":"Suppl 1","key":"974_CR42","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2025.110767","volume":"215","author":"J Djakow","year":"2025","unstructured":"Djakow J, Turner NM, Skellett S, Buysse CMP, Cardona F, de Lucas N et al (2025) European Resuscitation Council Guidelines 2025 paediatric life support. Resuscitation 215(Suppl 1):110767. https:\/\/doi.org\/10.1016\/j.resuscitation.2025.110767","journal-title":"Resuscitation"},{"issue":"12","key":"974_CR43","doi-asserted-by":"publisher","first-page":"2112","DOI":"10.1007\/s00134-018-5453-9","volume":"44","author":"P Jakkula","year":"2018","unstructured":"Jakkula P, Reinikainen M, Hastbacka J, Loisa P, Tiainen M, Pettila V et al (2018) Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial. Intensive Care Med 44(12):2112\u20132121. https:\/\/doi.org\/10.1007\/s00134-018-5453-9","journal-title":"Intensive Care Med"},{"issue":"2","key":"974_CR44","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1007\/s10877-024-01244-0","volume":"39","author":"G Gu","year":"2025","unstructured":"Gu G, Jiang J, Zheng B, Li Y, Luo Y, Pu Y et al (2025) Regional cerebral oxygen saturation in the healthy population of western Sichuan: a multicenter cross-sectional study. J Clin Monit Comput 39(2):283\u2013289. https:\/\/doi.org\/10.1007\/s10877-024-01244-0","journal-title":"J Clin Monit Comput"},{"issue":"25","key":"974_CR45","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000042992","volume":"104","author":"SJ Ryu","year":"2025","unstructured":"Ryu SJ, Lee BK, Lee DH, Kim DK, Cho YS, Lee JH et al (2025) The association between regional cerebral oxygen saturation and neurological outcomes in cardiac arrest survivors. Medicine (Baltimore) 104(25):e42992. https:\/\/doi.org\/10.1097\/MD.0000000000042992","journal-title":"Medicine (Baltimore)"},{"key":"974_CR46","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.resuscitation.2016.02.009","volume":"102","author":"GM Eastwood","year":"2016","unstructured":"Eastwood GM, Tanaka A, Bellomo R (2016) Cerebral oxygenation in mechanically ventilated early cardiac arrest survivors: the impact of hypercapnia. Resuscitation 102:11\u201316. https:\/\/doi.org\/10.1016\/j.resuscitation.2016.02.009","journal-title":"Resuscitation"},{"key":"974_CR47","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.resuscitation.2016.03.023","volume":"104","author":"GM Eastwood","year":"2016","unstructured":"Eastwood GM, Schneider AG, Suzuki S, Peck L, Young H, Tanaka A et al (2016) Targeted therapeutic mild hypercapnia after cardiac arrest: a phase II multi-centre randomised controlled trial (the CCC trial). Resuscitation 104:83\u201390. https:\/\/doi.org\/10.1016\/j.resuscitation.2016.03.023","journal-title":"Resuscitation"},{"issue":"3","key":"974_CR48","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/j.ccrj.2024.06.001","volume":"26","author":"HO Guldbrandsen","year":"2024","unstructured":"Guldbrandsen HO, Juhl-Olsen P, Eastwood GM, Wethelund KL, Grejs AM (2024) Sonographic evaluation of intracranial hemodynamics and pressure after out-of-hospital cardiac arrest: an exploratory sub-study of the TAME trial. Crit Care Resusc 26(3):176\u2013184. https:\/\/doi.org\/10.1016\/j.ccrj.2024.06.001","journal-title":"Crit Care Resusc"},{"issue":"1","key":"974_CR49","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1056\/NEJMoa2214552","volume":"389","author":"G Eastwood","year":"2023","unstructured":"Eastwood G, Nichol AD, Hodgson C, Parke RL, McGuinness S, Nielsen N et al (2023) Mild hypercapnia or normocapnia after out-of-hospital cardiac arrest. N Engl J Med 389(1):45\u201357. https:\/\/doi.org\/10.1056\/NEJMoa2214552","journal-title":"N Engl J Med"},{"key":"974_CR50","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2024.110295","volume":"201","author":"MB Melberg","year":"2024","unstructured":"Melberg MB, Flaa A, Andersen GO, Sunde K, Bellomo R, Eastwood G et al (2024) Effects of mild hypercapnia on myocardial injury after out-of-hospital cardiac arrest. A sub-study of the TAME trial. Resuscitation 201:110295. https:\/\/doi.org\/10.1016\/j.resuscitation.2024.110295","journal-title":"Resuscitation"},{"key":"974_CR51","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2023.109970","volume":"193","author":"MB Melberg","year":"2023","unstructured":"Melberg MB, Flaa A, Andersen GO, Sunde K, Bellomo R, Eastwood G et al (2023) Cardiovascular changes induced by targeted mild hypercapnia after out of hospital cardiac arrest. A sub-study of the TAME cardiac arrest trial. Resuscitation 193:109970","journal-title":"Resuscitation"},{"issue":"2","key":"974_CR52","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000634","volume":"4","author":"SR Bauer","year":"2022","unstructured":"Bauer SR, Sacha GL, Siuba MT, Lam SW, Reddy AJ, Duggal A et al (2022) Association of arterial pH with hemodynamic response to vasopressin in patients with septic shock: an observational cohort study. Crit Care Explor 4(2):e0634. https:\/\/doi.org\/10.1097\/CCE.0000000000000634","journal-title":"Crit Care Explor"},{"key":"974_CR53","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2024.110480","volume":"207","author":"GM Eastwood","year":"2025","unstructured":"Eastwood GM, Bailey M, Nichol AD, Parke R, Nielsen N, Dankiewicz J et al (2025) Impact of mild hypercapnia on renal function after out-of-hospital cardiac arrest. Resuscitation 207:110480. https:\/\/doi.org\/10.1016\/j.resuscitation.2024.110480","journal-title":"Resuscitation"},{"key":"974_CR54","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ajem.2024.12.060","volume":"90","author":"S Zhong","year":"2025","unstructured":"Zhong S, Yang Y, Peng W, Li W, Wang L, Zheng D et al (2025) Impact of normocapnia vs. mild hypercapnia on prognosis after cardiac arrest: a systematic review and meta-analysis. Am J Emerg Med 90:1\u20138. https:\/\/doi.org\/10.1016\/j.ajem.2024.12.060","journal-title":"Am J Emerg Med"},{"key":"974_CR55","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2025.110620","volume":"211","author":"MJ Holmberg","year":"2025","unstructured":"Holmberg MJ, Ikeyama T, Garg R, Drennan IR, Lavonas EJ, Bray JE et al (2025) Oxygen and carbon dioxide targets after cardiac arrest: an updated systematic review. Resuscitation 211:110620. https:\/\/doi.org\/10.1016\/j.resuscitation.2025.110620","journal-title":"Resuscitation"},{"key":"974_CR56","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.ajem.2024.12.030","volume":"89","author":"X Qiu","year":"2025","unstructured":"Qiu X, Zhang Y, Wang Q, Jiang Z, Kong L, Zhou L (2025) Effect of hypercapnia on neurologic outcomes after cardiac arrest: a systematic review and meta-analysis. Am J Emerg Med 89:5\u201311. https:\/\/doi.org\/10.1016\/j.ajem.2024.12.030","journal-title":"Am J Emerg Med"},{"issue":"3","key":"974_CR57","doi-asserted-by":"publisher","DOI":"10.1016\/j.accpm.2025.101522","volume":"44","author":"RT Xue","year":"2025","unstructured":"Xue RT, Sun RH, Wang M, Guo H, Chang J (2025) Association between arterial carbon dioxide tension and poor outcomes after cardiac arrest: a meta-analysis. Anaesth Crit Care Pain Med 44(3):101522. https:\/\/doi.org\/10.1016\/j.accpm.2025.101522","journal-title":"Anaesth Crit Care Pain Med"},{"issue":"1","key":"974_CR58","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-020-01162-z","volume":"20","author":"D Zhou","year":"2020","unstructured":"Zhou D, Li Z, Zhang S, Wu L, Li Y, Shi G et al (2020) Mild hypercapnia improves brain tissue oxygen tension but not diffusion limitation in asphyxial cardiac arrest: an experimental study in pigs. BMC Anesthesiol 20(1):252. https:\/\/doi.org\/10.1186\/s12871-020-01162-z","journal-title":"BMC Anesthesiol"},{"issue":"1","key":"974_CR59","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.resuscitation.2006.03.007","volume":"71","author":"E Cavus","year":"2006","unstructured":"Cavus E, Bein B, Dorges V, Stadlbauer KH, Wenzel V, Steinfath M et al (2006) Brain tissue oxygen pressure and cerebral metabolism in an animal model of cardiac arrest and cardiopulmonary resuscitation. Resuscitation 71(1):97\u2013106. https:\/\/doi.org\/10.1016\/j.resuscitation.2006.03.007","journal-title":"Resuscitation"},{"key":"974_CR60","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.resuscitation.2018.10.024","volume":"135","author":"G Babini","year":"2019","unstructured":"Babini G, Ristagno G, Boccardo A, De Giorgio D, De Maglie M, Affatato R et al (2019) Effect of mild hypercapnia on outcome and histological injury in a porcine post cardiac arrest model. Resuscitation 135:110\u2013117. https:\/\/doi.org\/10.1016\/j.resuscitation.2018.10.024","journal-title":"Resuscitation"},{"key":"974_CR61","doi-asserted-by":"publisher","DOI":"10.1016\/j.resplu.2024.100604","author":"H Karlsen","year":"2024","unstructured":"Karlsen H, Strand-Amundsen RJ, Skare C, Eriksen M, Skulberg VM, Sunde K et al (2024) Cerebral perfusion and metabolism with mild hypercapnia vs. normocapnia in a porcine post cardiac arrest model with and without targeted temperature management. Resusc Plus. https:\/\/doi.org\/10.1016\/j.resplu.2024.100604","journal-title":"Resusc Plus"},{"issue":"12","key":"974_CR62","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000041479","volume":"104","author":"G Lu","year":"2025","unstructured":"Lu G, Rili G, Shuang M (2025) Impact of hypoxia on the hippocampus: a review. Medicine (Baltimore) 104(12):e41479. https:\/\/doi.org\/10.1097\/MD.0000000000041479","journal-title":"Medicine (Baltimore)"},{"key":"974_CR63","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2024.110196","volume":"201","author":"GD Perkins","year":"2024","unstructured":"Perkins GD, Neumar R, Hsu CH, Hirsch KG, Aneman A, Becker LB et al (2024) Improving outcomes after post-cardiac arrest brain injury: a scientific statement from the international liaison committee on resuscitation. Resuscitation 201:110196. https:\/\/doi.org\/10.1016\/j.resuscitation.2024.110196","journal-title":"Resuscitation"},{"issue":"7","key":"974_CR64","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1016\/j.healun.2025.03.006","volume":"44","author":"G Beer","year":"2025","unstructured":"Beer G, Egle M, Graf S, Segiser A, Clavier A, Helmer A et al (2025) Response to hypercapnia as a tool to assess cardiac recovery in a porcine model of DCD heart transplantation. J Heart Lung Transplant 44(7):1181\u20131185. https:\/\/doi.org\/10.1016\/j.healun.2025.03.006","journal-title":"J Heart Lung Transplant"},{"issue":"1","key":"974_CR65","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-0896-7","volume":"19","author":"A Kimmoun","year":"2015","unstructured":"Kimmoun A, Novy E, Auchet T, Ducrocq N, Levy B (2015) Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside. Crit Care 19(1):175. https:\/\/doi.org\/10.1186\/s13054-015-0896-7","journal-title":"Crit Care"},{"issue":"1","key":"974_CR66","doi-asserted-by":"publisher","DOI":"10.1186\/s40560-024-00745-z","volume":"12","author":"Y Endo","year":"2024","unstructured":"Endo Y, Aoki T, Jafari D, Rolston DM, Hagiwara J, Ito-Hagiwara K et al (2024) Acute lung injury and post-cardiac arrest syndrome: a narrative review. J Intensive Care 12(1):32. https:\/\/doi.org\/10.1186\/s40560-024-00745-z","journal-title":"J Intensive Care"},{"issue":"9","key":"974_CR67","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1164\/rccm.201609-1771OC","volume":"195","author":"JR Beitler","year":"2017","unstructured":"Beitler JR, Ghafouri TB, Jinadasa SP, Mueller A, Hsu L, Anderson RJ et al (2017) Favorable neurocognitive outcome with low tidal volume ventilation after cardiac arrest. Am J Respir Crit Care Med 195(9):1198\u20131206. https:\/\/doi.org\/10.1164\/rccm.201609-1771OC","journal-title":"Am J Respir Crit Care Med"}],"container-title":["Intensive Care Medicine Experimental"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40635-026-00974-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40635-026-00974-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40635-026-00974-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T09:04:06Z","timestamp":1789722246000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40635-026-00974-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":67,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["974"],"URL":"https:\/\/doi.org\/10.1186\/s40635-026-00974-6","relation":{},"ISSN":["2197-425X"],"issn-type":[{"value":"2197-425X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]},"assertion":[{"value":"17 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"During the preparation of this work, the authors used ChatGPT (OpenAI, San Francisco, CA, USA) to improve readability and language. The authors reviewed and edited the content as needed and take full responsibility for the final manuscript.","order":1,"name":"Ethics","label":"Generative AI in scientific writing","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that there is no conflict of interest regarding the publication of this article.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"122"}}