A . G . Beshish et al .: J Extra Corpor Technol 2024 , 56 , 174 – 184 181
Table 3 . Causes of comorbidity and death , and reintervention for patients requiring ECLS post-Norwood Operation .
Cause of death |
Total number of deaths n = 38 (%) |
Multi organ failure |
12 ( 31.6 %) |
Withdrawal of support / redirection of goals of care |
10 ( 26.3 %) |
Cardiac arrest after ECLS decannulation |
6 ( 15.8 %) |
Sepsis / septic shock |
5 ( 13.2 %) |
severe neurological injury |
5 ( 13.2 %) |
Reintervention |
Total number reintervention n = 6 / 65 ( 9.2 %) |
Revision of Aortic Arch / Revision of ( DKS ) Damus Kaye Stansel |
5 |
Shunt revision |
1 |
Table 4 . Functional Status Scale ( FSS ) for post-Norwood ECLS survivors on admission and discharge stratified by PaO 2 levels into hyperoxia group ( PaO 2 > 182 mmHg ) and non-hyperoxia group ( PaO 2 182 mmHg ).
ECLS group |
FSS domain |
Admission |
Discharge |
p-value |
|
|
Mean |
SD |
Mean |
SD |
|
Non-Hyperoxia Group ( PaO 2 182 mmHg ) ( n = 19 ) |
Mental Status |
1 |
0 |
1.1 |
0.5 |
0.331 |
|
Sensory Function |
1 |
0 |
1 |
0 |
– |
|
Communication |
1 |
0 |
1.1 |
0.2 |
0.331 |
|
Motor Functioning |
1 |
0 |
1.1 |
0.5 |
< 0.0001 |
|
Feeding |
1 |
0 |
2.9 |
0.5 |
0.042 |
|
Respiratory Status |
1 |
0 |
1.2 |
0.4 |
< 0.0001 |
|
Total Score |
6 |
0 |
8.4 |
1.2 |
< 0.0001 |
Hyperoxia Group ( PaO 2 > 182 mmHg ) ( n = 8 ) |
Mental Status |
1 |
0 |
1.1 |
0.4 |
0.351 |
|
Sensory Function |
1 |
0 |
1.1 |
0.4 |
0.351 |
|
Communication |
1 |
0 |
1.1 |
0.4 |
0.351 |
|
Motor Functioning |
1 |
0 |
1 |
0 |
– |
|
Feeding |
1 |
0 |
3 |
0 |
– |
|
Respiratory Status |
1 |
0 |
1.4 |
0.7 |
0.197 |
|
Total Score |
6 |
0 |
8.8 |
1.4 |
0.001 |
Results depicted as mean , and standard deviation ( SD ). Subscale scores range from 1 to 5 . Total scores are the sum of subscale scores ranging from 6 to 30 . p-value : paired t-tests
Table 5 . New morbidity and unfavorable functional outcome for overall survivors who required ECLS post-Norwood operation stratified by PaO 2 levels into hyperoxia and non-hyperoxia groups based on functional status scale change from admission to discharge .
ECLS group
New morbidity ( change in FSS score 3 points )
Unfavorable outcome ( change in FSS score 5 points )
Overall Cohort of Survivors ( n = 27 ) |
7 ( 26 %) |
2 ( 7 %) |
Non-Hyperoxia Group Survivors ( n = 19 ) ( PaO 2 182 mmHg ) |
4 ( 21 %) |
1 ( 5 %) |
Hyperoxia Group Survivors ( n = 8 ) ( PaO 2 > 182 mmHg ) |
3 ( 38 %) |
1 ( 13 %) |
FSS : Functional Status Scale ; ECLS : Extracorporeal Life Support .
Despite previous studies , there is no generally accepted definition of pathologic hyperoxia . Injurious hyperoxia may vary by patient population and clinical context [ 32 ]. As we know , the oxygen content of blood consists of bound oxygen to hemoglobin , and dissolved oxygen in the form of PaO 2 . Despite knowing that the bound oxygen by far is the main contributor for oxygen content in blood , the dissolved oxygen ( PaO 2 ) is what is important at the cellular level . Poor outcomes may occur when PaO 2 exceeds a certain threshold of antioxidation systems of the body . This is biologically plausible as endogenous antioxidants may prevent oxidative stress at lower PaO 2 . Whenhigh amounts of oxygen are introduced to previously ischemic tissues , this leads to the generation of reactive oxygen species ( ROS ) and activation of inflammatory pathways via cytokines and other immunological signaling pathways . The generation of oxygen free radicals causes damage to the cell membrane integrity due to lipid peroxidation and protein changes , ultimately resulting in premature cell death [ 36 ]. Production of ROS can result in the dysfunction of organ systems including the immune system . This dysregulation may result in multiorgan dysfunction in the form of renal failure , cardiac dysfunction , and respiratory failure . These may ultimately increase the overall