J Extra Corpor Technol 2026, 58, 32 – 38 Ó The Author( s), published by EDP Sciences, 2026 https:// doi. org / 10.1051 / ject / 2025057
Available online at: ject. edpsciences. org
ORIGINAL ARTICLE
Impact of early hyperoxia on outcomes during neonatal and pediatric veno-arterial extracorporeal life support w
Ashish Saini( MD) 1, Rebecca Shamah( MD) 2, Joshua Qian( MD) 2, Kasey Keane-Lerner( MPA, PA-C) 3, Paola Rodriguez Morales( MD) 2, Pranay Nayi( DDS, MPH) 4, Adithi Shyam( MPH) 4, Joel Davis( RRT-NPS) 5, Mohan John( MD) 6, Heather Viamonte( MD, MPH) 1, and Assad G Beshish( MD) 1,*
1 Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’ s Healthcare of Atlanta, Atlanta, GA, USA 2 Emory University School of Medicine, Atlanta, GA, USA 3 Physician Assistant, Children’ s Healthcare of Atlanta, Atlanta, GA, USA 4 Research Coordinator, Children’ s Healthcare of Atlanta, Atlanta, GA, USA 5 Advance 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 Received 9 July 2025, Accepted 12 October 2025
Abstract – Background: Hyperoxia induces oxidative stress and can exacerbate inflammatory response to Veno- Arterial Extracorporeal Life Support( VA – ECLS). This study aimed to evaluate the association between hyperoxia during VA – ECLS and morbidity, complications, and in-hospital mortality. Methods: This study included pediatric patients who received VA – ECLS between 2014 and 2019. Hyperoxia severity was categorized as mild( PaO 2: 101 – 200 mmHg), moderate( PaO 2: 201 – 300 mmHg), and severe( PaO 2 > 300 mmHg. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included a composite measure of cardiovascular or renal complications, AKI, and change in Functional Status. Results: Among 229 patients supported on VA – ECLS runs, 73.4 % involved neonates. Median age and weight of the entire cohort were 2.5 months( IQR 0.3, 19.0), and 4.4 kg( IQR 3.2, 10.7), respectively. Cardiac indications accounted for 48.9 % of cases. Hyperoxia occurred in 79 % of patients and was more common in those requiring ECLS for cardiac indications. The overall in-hospital mortality rate was 45 %, increasing to 64 % in the severe hyperoxia cohort( p = 0.23). Severe hyperoxia was significantly associated with the composite outcome of cardiovascular or renal complications but not in-hospital mortality in multivariable analysis. No association was found between hyperoxia, AKI, and adverse functional outcomes. Conclusions: Standardized PaO 2 targets to minimize hyperoxia may improve outcomes for patients supported on VA – ECLS.
Key words: Hyperoxia, ECLS, Mortality, ECLS Complications, Functional Status Scale.
Abbreviations
ABG AKI E – CPR ELSO FSS Score
PaO 2
VA – ECLS
Arterial Blood Gas Acute Kidney Injury Extracorporeal Cardiopulmonary Resuscitation
Extracorporeal Life Support Organization Functional Status Scale Score Partial Pressure of Oxygen Veno-Arterial Extracorporeal Life Support
w Presented at the Annual Pediatric Cardiac Intensive Care Society
meeting in November 2024 * Corresponding author: beshisha @ kidsheart. com; abeshish83 @ yahoo. com
Introduction
Hyperoxia has been associated with adverse clinical outcomes and increased mortality in various scenarios, including traumatic brain injury, perinatal asphyxia, critical illness, and post-resuscitation states [ 1 – 5 ]. Its deleterious effects are attributable to cellular dysfunction, inflammation, and necrosis due to enhanced production of reactive oxygen species [ 6 ]. Veno-arterial( VA) extracorporeal life support( ECLS) provides circulatory support by removing blood from the venous system and returning highly oxygenated blood to the arterial circulation. VA – ELCS is commonly used to support neonatal and pediatric patients with severe cardiopulmonary failure and after cardiac arrest [ 7 ]. However, ECLS itself induces systemic inflammation and oxidative stress similar to hyperoxia [ 8 ]. Therefore,
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