Dr Swapnil Pawar is joined by Dr Jose Chacko to discuss the LOGICAL trial, published in the New England Journal of Medicine in June 2026.

Does limiting oxygen after cardiac arrest protect the brain from reperfusion injury? LOGICAL (the largest randomised trial of oxygen therapy after cardiac arrest to date) randomised 1,840 patients across 53 ICUs in Australia, New Zealand and Ireland to conservative versus liberal oxygen therapy.

In this episode:
– The pathophysiological rationale: hypoxic-ischaemic encephalopathy, reperfusion injury and free radical damage
– Where LOGICAL sits alongside EXACT, ICU-ROX, HOT-ICU and the Danish BOX trial
– The Mega-ROX master protocol design, and why the sepsis and non-HIE brain injury arms are still to come
– Trial design: SpO₂ upper limit of 95% and FiO₂ down to 0.21 in the conservative arm versus no upper limit and a floor of FiO₂ 0.3 in the liberal arm
– The results: no difference in favourable neurological outcome at 180 days (38.2% vs 39.7%), survival, length of stay, quality of life or cognitive function
– Strengths, limitations, and what it means at the bedside, including why the hosts have landed in different places on titrating down to room air

Reference: The LOGICAL Investigators and the ANZICS Clinical Trials Group. Conservative Oxygen for Unresponsive Patients after Cardiac Arrest. N Engl J Med. 2026 Jun 10.

Full summary, outcome tables and references at critcareedu.com.au