J Extra Corpor Technol 2024 , 56 , 174 – 184 Ó The Author ( s ), published by EDP Sciences , 2024 https :// doi . org / 10.1051 / ject / 2024020
Available online at : ject . edpsciences . org
ORIGINAL ARTICLE
Determining the association of hyperoxia while on extracorporeal life support with mortality in neonates following Norwood operation
Asaad G . Beshish ( MD ) 1 ,* , Alaa Aljiffry ( MD ) 1 , Yijin Xiang ( MPH ) 2 , Sean Evans ( MD ) 3 , Amy Scheel ( MD ) 3 , Ashley Harriott ( BA ) 3 , Shayli Patel ( BA ) 3 , Alan Amedi ( BS ) 3 , Amanda Harding ( RDCS ( AE , PE )) 4 , Joel Davis ( RRT-NPS ) 5 , Subhadra Shashidharan ( MD ) 6 , and David M . Kwiatkowski ( MD ) 7
1 Department of Pediatrics , Division of Cardiology , Emory University School of Medicine , Children ’ s Healthcare of Atlanta , Atlanta , GA , USA 2 Biostatistician and Data Analyst , Department of Pediatrics , Emory University School of Medicine , Atlanta , GA , USA 3 Emory University School of Medicine , Atlanta , GA , USA 4 Senior Pediatric Cardiac Sonographer , Children ’ s Healthcare of Atlanta , Atlanta , GA , USA 5 Advanced Technology Coordinator , ECMO and Advanced Technologies , Children ’ s Healthcare of Atlanta , Atlanta , GA , USA 6 Department of Surgery , Division of Cardiothoracic Surgery , Emory University School of Medicine , Children ’ s Healthcare of Atlanta ,
Atlanta , GA , USA 7 Department of Pediatrics , Division of Cardiology , Stanford University School of Medicine , Lucile Packard Children ’ s Hospital ,
Stanford , CA , USA Received 24 April 2024 , Accepted 22 July 2024
Abstract – Background : Patients requiring extracorporeal life support ( ECLS ) support post-Norwood operation constitute an extremely high-risk group . Materials and methods : We retrospectively aimed to evaluate the relationship of hyperoxia with mortality and other clinical outcomes in patients who required ECLS following Norwood operation between January / 2010 and December / 2020 in a large volume center . Results : During the study period 65 patients required ECLS post-Norwood . Using receiver operating characteristic ( ROC ) curve analysis , mean PaO 2 of 182 mmHg in the first 48-hour on ECLS was determined to have the optimal discriminatory ability for mortality ( sensitivity 68 %, specificity 70 %). Of the 65 patients , 52 % had PaO 2 > 182 mmHg and were designated as hyperoxia group . Patients in the hyperoxia-group had longer cardiopulmonary bypass time ( 187 vs . 165 min , p = 0.023 ), shorter duration from CICU arrival to ECLS-cannulation ( 13.28 vs . 132.58 h , p = 0.003 ), higher serum lactate within 2-hours from ECLS-canulation ( 14.55 vs . 5.80 , p = 0.01 ), higher ECLS flows in the first 4-hours ( 152.68 vs . 124.14 , p = 0.006 ), and higher mortality ( 77 % vs . 39 %, p = 0.005 ). In the unadjusted-analysis , using a derived cut-point , patients in the hyperoxia-group had 5.15 higher odds of mortality ( p = 0.003 ). However , this association was insignificant when adjusting for confounding variables ( p = 0.104 ). Using a functional status scale , new morbidity ( 38 % vs . 21 %), and unfavorable outcomes ( 13 % vs . 5 %) were higher in the hyperoxia group . Despite being higher in the hyperoxia group , this did not reach statistical significance . Conclusion : Neonates with hyperoxia ( PaO 2 > 182 Torr ) during the first 48-hour of ECLS post-Norwood operation had 5 times higher odds of mortality in the unadjusted analysis , however , this was insignificant when adjusting for confounding variables . Patients in the hyperoxia group had shorter duration from CICU arrival to ECLS-cannulation , higher serum lactate prior to ECLS-canulation , and higher ECLS flows in the first 4-hours , ( p < 0.05 ). Multicenter evaluation of this modifiable risk factor is imperative to improve the care of this high-risk cohort .
Key words : Univentricular Physiology , Norwood Operation , Extracorporeal Life Support ( ECLS ), Hyperoxia , Functional Status Scale ( FSS ), New Morbidity , Unfavorable Outcomes .
* Corresponding author : beshisha @ kidsheart . com ; abeshis @ emory . edu
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