Assistant Professor of Pediatrics Emory University School of Medicine, Children's Healthcare of Atlanta Atlanta, Georgia, United States
Abstract:
Background: Patients requiring extracorporeal life support (ECLS) due to cardiopulmonary failure are frequently exposed to supranormal blood oxygen tension (hyperoxia). Recent studies suggested that hyperoxia is associated with worse outcomes in patients with congenital heart disease after exposure to extracorporeal technology. There is limited data regarding the effects of hyperoxia in univentricular patients requiring ECLS following Norwood operation. We sought to evaluate the potential association of hyperoxia with inpatient mortality and other clinical outcomes among neonates requiring ECLS post-Norwood operation in a large volume center.
Method: Retrospective single-center study at an academic children’s hospital. All neonates who underwent ECLS post-Norwood operation between January 2010 and December 2020 were included. Medical records were reviewed for patient characteristics, clinical variables, average partial arterial pressure of oxygen (PaO2) during the first 48hours of ECLS, and clinical outcomes. Analysis was performed using appropriate statistics with a significance level set at p=0.05.
Results: Sixty-five patients required ECLS post-Norwood. Using a receiver operating characteristic curve, a mean PaO2 of 182 mmHg in the first 48-hours on ECLS was determined to have the optimal discriminatory ability with regard to operative mortality, with sensitivity (68%) and specificity (70%). Of the 65 patients, 34 (52%) had PaO2 > 182 mmHg and were categorized as hyperoxia group. Patients in the hyperoxia group had more Sano shunts (82% vs 29%), longer median cardiopulmonary bypass time (187 vs 165 minutes), and higher vasoactive inotropic score in the first 48-hours. Patients in the hyperoxia group had higher operative mortality (77% vs 39%, p< 0.05) when compared to the non-hyperoxia group.
Conclusion: Hyperoxia during the first 48hours of ECLS in univentricular patients requiring ECLS post-Norwood operation was associated with a higher risk for operative mortality. Multicenter and prospective evaluation of this modifiable risk factor is imperative to improve the care of this high-risk cohort.
