A. G. Beshish et al.: J Extra Corpor Technol 2025, 57, 129 – 136 133
Table 2. Outcomes of patients undergoing VA-ECLS using a univariable and multivariable regression analysis.
Variables |
Non-Hyperoxia Group |
Hyperoxia Group |
OR( 95 % CI) |
p-value |
aOR a( 95 % CI) |
Adjusted p-value |
|
PaO 2 232 mmHg( n = 161) |
PaO 2 > 232 mmHg( n = 68) |
|
|
|
|
Mortality |
65( 40.4 %) |
37( 54.4 %) |
1.76( 0.995 – 3.12) |
0.052 |
2.02( 1.03 – 3.97) |
0.03 |
Any Cardiovascular, Renal, |
113( 70.2 %) |
54( 79.4 %) |
1.29( 0.63 – 2.64) |
0.478 |
1.96( 0.89 – 4.35) |
0.10 |
or Mechanical complication |
|
|
|
|
|
|
Stage II / III AKI ** |
111( 74.5 %) |
49( 79.0 %) |
1.64( 0.83 – 3.23) |
0.154 |
2.12( 0.82 – 5.50) |
0.12 |
a
Adjusted for age( months) and mode of VA-ECLS.
Table 3. New morbidity and unfavorable functional outcome for overall survivors who required VA-ECLS stratified by PaO 2 levels into hyperoxia and non-hyperoxia groups based on functional status scale change from admission to discharge.
ECLS Group
Overall cohort of survivors( n = 127)
Non-hyperoxia group Hyperoxia group p-value
PaO 2 233 mmHg( n = 96)
PaO 2 > 233 mmHg( n = 31)
New morbidity( Change in FSS score 3 points) |
30( 23.6 %) |
21( 21.9 %) |
9( 29.0 %) |
0.415 |
Unfavorable outcome( Change in FSS score 5 points) |
10( 7.9 %) |
8( 8.3 %) |
2( 6.5 %) |
0.735 |
FSS Subscale scores range from 1 to 5. Total scores are the sum of subscale scores, ranging from 6 to 30. FSS: Functional Status Scale; ECLS: Extracorporeal Life Support. Figure 2. Flow chart of neonates requiring Veno-arterial Extracorporeal Life Support( VA-ECLS) stratified based on PaO 2 levels in the first 48 h while on ECLS.
In a prior report, we showed that a substantial portion of infants undergoing cardiac surgery using CPB were exposed to hyperoxia and that patients in the hyperoxia group had four-fold greater odds of mortality within 30 days of surgery [ 9 ]. This report supports earlier findings that hyperoxia is likely associated with worse outcomes, but which populations are at risk remains unclear, and the impact of other clinical variables that may affect oxygenation in a direct or indirect way. Some of these factors are patient hemoglobin levels, ventilator settings
Figure 3. Scatterplot illustrating the relationship of average PaO 2, VA-ECLS run duration, and mortality in the VA-ECLS Cohort.
including FiO 2, the health and age of the oxygenator in the ECLS circuit, ECLS flows, recirculation, and whether the patient is sedated and paralyzed to decrease oxygen consumption. It would be extremely useful to control these factors, but in reality, the degree of impact of each factor is different for each patient. This really supports the importance of this study and future studies to help understand the true impact of oxygen on patient outcomes and on the biological systems of the body.