Impact of early hyperoxia on outcomes during neonatal and pediatric veno-arterial extracorporeal life support

TL;DR

This study found that severe hyperoxia during VA–ECLS is linked to more complications but not higher mortality in neonatal and pediatric patients.

Contribution

The study provides new evidence on the impact of hyperoxia severity during VA–ECLS in pediatric patients.

Findings

Severe hyperoxia was associated with increased cardiovascular or renal complications.

Severe hyperoxia did not significantly increase in-hospital mortality.

Hyperoxia was more common in patients with cardiac indications for VA–ECLS.

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 (PaO2: 101–200 mmHg), moderate (PaO2: 201–300 mmHg), and severe (PaO2 > 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 PaO2 targets to minimize hyperoxia may improve outcomes for patients supported on VA–ECLS.

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