J Extra Corpor Technol 2025, 57, 59 – 65 Ó The Author( s), published by EDP Sciences, 2025 https:// doi. org / 10.1051 / ject / 2024013
Available online at: ject. edpsciences. org
ORIGINAL ARTICLE
Is hyperoxia in early pediatric veno-veno extracorporeal life support associated with mortality?
Asaad G. Beshish( MD) 1,*, Paola Rodriguez-Morales( MD) 2, Rebecca Shamah( BS) 2, Joshua Qian( BS) 2, Kasey Keane-Lerner( MPA, PA-C) 3, Tawanda Zinyandu( MD, MPH) 3, Joel Davis( RRT-NPS) 4, Joshua M. Rosenblum( MD, PhD) 5, and Heather K. Viamonte( MD, MPH) 1
1 Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’ s Healthcare of Atlanta, 1405 Clifton Rd, NE Atlanta, GA 30322, USA 2 Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA 3 Children’ s Healthcare of Atlanta, 1405 Clifton Rd, NE Atlanta, GA 30322, USA 4 ECMO and Advanced Technologies, Children’ s Healthcare of Atlanta, 1405 Clifton Rd, NE Atlanta, GA 30322, USA 5 Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Children’ s Healthcare of Atlanta,
1405 Clifton Rd, NE Atlanta, GA 30322, USA Received 20 February 2024, Accepted 12 June 2024
Abstract – Background: Data is limited regarding the effects of supraphysiologic blood oxygen tension( hyperoxia) in patients requiring extracorporeal life support( ECLS). We sought to evaluate the association between hyperoxia and outcomes in pediatric patients requiring veno-venous( VV) ECLS. Methods: Retrospective single-center study at an academic children’ s hospital, Children’ s Healthcare of Atlanta, Emory University School of Medicine that included all patients 0 – 18 years who required VV-ECLS between 01 / 2014 and 12 / 2019. Results: During the study period 110 VV-ECLS runs occurred in 110 patients. Using a receiver operating characteristic curve, a mean partial pressures of oxygen( PaO 2) of 122 mmHg in the first 48 hours of ECLS was determined to have the optimal discriminatory ability with regard to mortality( sensitivity 41 % and specificity 86 %). Of the VV-ECLS runs, 68( 61.8 %) had PaO 2 > 122 mmHg( hyperoxia group). The hyperoxia group tended to be older( 105.4 vs. 1.6 months, p = 0.001), had higher rates of hemorrhagic complications( 69.6 % vs. 25.3 %, p = 0.0001), and higher mortality rate( 57.9 % vs. 19.5 %, p = 0.002). Adjusting for confounders, the hyperoxia group had higher odds of mortality( OR: 7.97, 95 % CI: 1.72 – 36.86, p = 0.0079). Conclusion: Children exposed to hyperoxia during the first 48 h of VV-ECLS were 8 times more likely to die than those who were not after adjusting for confounders( age group, body surface area, and indication for ECLS). Multicenter and prospective evaluation of this modifiable risk factor is imperative to improving the care of this high-risk cohort.
Key words: Extracorporeal life support( ECLS), Hyperoxia, Veno-veno extracorporeal life support( VV-ECLS), Mortality, Functional Status Scale( FSS).
Introduction
Extracorporeal life support( ECLS) is commonly used to support patients with reversible cardiopulmonary failure refractory to conventional medical treatment. While typically deployed as a bridge-to-recovery, ECLS can also be utilized as a bridge-to-bridge, bridge-to-transplantation, or bridge-todecision [ 1, 2 ]. Since the introduction of ECLS in the mid- 1970s, a steady increase in the number and complexity of patients supported has occurred. The most recent ELSO registry report in 2022 demonstrated almost 35,000 neonatal and pediatric patients supported with ECLS with an overall survival rate of about 50 % [ 3 ].
During veno-veno( VV-) ECLS, deoxygenated blood is removed from the venous side of the circulation, oxygenated, and pumped back to the venous side via the same vein( double lumen cannula) or through a different vein( single lumen cannula). These circuits utilize a highly efficient oxygenator resulting in high partial pressures of oxygen( PaO 2) that can exceed 400 – 500 mmHg. Exposure to these supranormal levels of oxygen is termed hyperoxia. Hyperoxia has been well studied in various clinical scenarios in both adults and children
* Corresponding author: beshisha @ kidsheart. com; abeshis @ emory. edu
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