A. Saini et al.: J Extra Corpor Technol 2026, 58, 32 – 38 37
Table 4. Outcomes of patients undergoing VA – ECLS using a univariable and multivariable regression analysis amongst neonates( age 30 days) n = 168.
Variables |
OR( 95 % CI) |
p-Value |
aOR a( 95 % CI) |
Adjusted p-value |
Mortality Mild vs Ref. |
0.9( 0.4 – 1.9) |
0.40 |
0.9( 0.4 – 2.0) |
0.39 |
Moderate vs Ref. |
0.7( 0.3 – 1.7) |
0.09 |
0.8( 0.3 – 1.9) |
0.19 |
Severe vs Ref. |
2.7( 0.9 – 8.1) |
0.03 |
2.4( 0.7 – 8.1) |
0.06 |
Any Cardiovascular or Renal complications |
Mild vs Ref. |
1.3( 0.6 – 2.7) |
0.06 |
1.2( 0.5 – 2.6) |
0.09 |
Moderate vs Ref. |
1.7( 0.7 – 4.1) |
0.36 |
1.4( 0.5 – 3.7) |
0.30 |
Severe vs Ref. |
15.3( 1.9 – 124.1) |
0.01 |
11.9( 1.4 – 100.4) |
0.03 |
Stage II / III AKI ** Mild vs Ref. |
1.1( 0.4 – 2.7) |
0.21 |
1.2( 0.4 – 3.2) |
0.15 |
Moderate vs Ref. |
1.1( 0.4 – 3.1) |
0.25 |
1.3( 0.4 – 4.5) |
0.27 |
Severe vs Ref. |
11.3( 0.6 – 221.9) |
0.11 |
19.4( 0.8 – 452.9) |
0.07 |
Reference group = Normoxia( PaO 2 100). Mild Hyperoxia( PaO 2 = 101 – 200 mmHg); Moderate Hyperoxia( PaO 2 = 201 – 300 mmHg); Severe Hyperoxia( PaO 2 > 300 mmHg). ** Stage II AKI: Stage 2: serum creatinine increase of 2 – 2.9 times baseline, or UO < 0.5 mL / kg / h for 12 h; Stage III AKI: serum creatinine increase 3 times baseline or 4 mg / dL, or UO < 0.3 mL / kg / h for 24 h or anuria 12 h, or need for renal replacement therapy. a Adjusted for age group, BSA, indication for ECLS.
Table 5. New morbidity and unfavorable functional outcome for survivors who required VA – ECLS stratified by hyperoxia.
ECLS group |
PaO 2 100 mmHg |
PaO 2 101 – 200 mmHg |
PaO 2 201 – 300 mmHg |
PaO 2 > 300 mmHg |
p-Value |
|
( n = 29) |
( n = 53) |
( n = 35) |
( n = 9) |
|
New morbidity |
6( 20.7 %) |
12( 22.2 %) |
10( 28.6 %) |
2( 22.2 %) |
0.88 2 |
Unfavorable outcome |
2( 6.9 %) |
5( 9.3 %) |
3( 8.6 %) |
0( 0.0 %) |
0.81 2 |
Total scores are the sum of subscale scores, ranging from 6 to 30. New Morbidity: Change in FSS score by 3 points. Unfavorable Outcome: Change in FSS score by 5 points. FSS: Functional Status Scale; ECLS: Extracorporeal Life Support. FSS Subscale scores range from 1 to 5. at dedicated time intervals, it is not possible to distinguish the effect of prolonged hyperoxia exposure from those of acute spikes in PaO 2 levels. Additionally, the sample size may be insufficient to fully assess the impact of hyperoxia on the outcomes. Importantly, many of these limitations can be addressed in a multicenter validation study, which our group is currently pursuing.
Conclusion
Our study demonstrates an association between hyperoxia and adverse outcomes in VA – ECLS patients, particularly among neonates and those with cardiac indication. Severe hyperoxia was associated with increased cardiovascular and renal complications. Given the variability in PaO 2 targets, standardized guidelines must be formulated and investigated to validate these findings and optimize oxygen management strategies during VA ECLS.
Funding This research received no external funding.
Conflicts of interest The authors have no conflicts of interest and nothing to disclose.
Data availability statement
Data is not available for this article to the public per the CHOA IRB regulations.
Author contribution statement
Ashish Saini reviewed the analysis. As the lead author, he drafted the initial and revised versions of the manuscript.
Rebecca Shamah, Joshua Qian, Kasey Keane-Lerner, and Paola Rodriguez Morales performed data collection for this study.
Pranay Nayi and Adithi Shyam provided statistical expertise for analyzing and reporting the results.
Joel Davis was involved in project administration and data validation.
Mohan John provided oversight, reviewed, revised, and approved the final manuscript.
Heather Viamonte provided oversight, reviewed, revised, and approved the final manuscript.
Assad G. Beshish is the senior author of this project. He oversaw the design of the study, data collection, analysis, and drafting of the manuscript. He reviewed, revised, and approved the final manuscript.
Ethics approval
The study was approved by the CHOA Institutional Review Board( IRB # 00001239), with informed consent waived.