Determining the association of hyperoxia while on extracorporeal life support with mortality in neonates following Norwood operation
Background: Patients requiring extracorporeal life support (ECLS) support post-Norwood operation constitute an extremely high-risk group. Materials and methods: We retrospectively aimed to evaluate the relationship of hyperoxia with mortality and other clinical outcomes in patients who required ECLS...
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EDP Sciences
2024-12-01
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| Series: | The Journal of ExtraCorporeal Technology |
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| Online Access: | https://ject.edpsciences.org/articles/ject/full_html/2024/04/ject240021/ject240021.html |
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| author | Beshish Asaad G. Aljiffry Alaa Xiang Yijin Evans Sean Scheel Amy Harriott Ashley Patel Shayli Amedi Alan Harding Amanda Davis Joel Shashidharan Subhadra Kwiatkowski David M. |
| author_facet | Beshish Asaad G. Aljiffry Alaa Xiang Yijin Evans Sean Scheel Amy Harriott Ashley Patel Shayli Amedi Alan Harding Amanda Davis Joel Shashidharan Subhadra Kwiatkowski David M. |
| author_sort | Beshish Asaad G. |
| collection | DOAJ |
| description | Background: Patients requiring extracorporeal life support (ECLS) support post-Norwood operation constitute an extremely high-risk group. Materials and methods: We retrospectively aimed to evaluate the relationship of hyperoxia with mortality and other clinical outcomes in patients who required ECLS following Norwood operation between January/2010 and December/2020 in a large volume center. Results: During the study period 65 patients required ECLS post-Norwood. Using receiver operating characteristic (ROC) curve analysis, mean PaO2 of 182 mmHg in the first 48-hour on ECLS was determined to have the optimal discriminatory ability for mortality (sensitivity 68%, specificity 70%). Of the 65 patients, 52% had PaO2 > 182 mmHg and were designated as hyperoxia group. Patients in the hyperoxia-group had longer cardiopulmonary bypass time (187 vs. 165 min, p = 0.023), shorter duration from CICU arrival to ECLS-cannulation (13.28 vs. 132.58 h, p = 0.003), higher serum lactate within 2-hours from ECLS-canulation (14.55 vs. 5.80, p = 0.01), higher ECLS flows in the first 4-hours (152.68 vs. 124.14, p = 0.006), and higher mortality (77% vs. 39%, p = 0.005). In the unadjusted-analysis, using a derived cut-point, patients in the hyperoxia-group had 5.15 higher odds of mortality (p = 0.003). However, this association was insignificant when adjusting for confounding variables (p = 0.104). Using a functional status scale, new morbidity (38% vs. 21%), and unfavorable outcomes (13% vs. 5%) were higher in the hyperoxia group. Despite being higher in the hyperoxia group, this did not reach statistical significance. Conclusion: Neonates with hyperoxia (PaO2 > 182 Torr) during the first 48-hour of ECLS post-Norwood operation had 5 times higher odds of mortality in the unadjusted analysis, however, this was insignificant when adjusting for confounding variables. Patients in the hyperoxia group had shorter duration from CICU arrival to ECLS-cannulation, higher serum lactate prior to ECLS-canulation, and higher ECLS flows in the first 4-hours, (p < 0.05). Multicenter evaluation of this modifiable risk factor is imperative to improve the care of this high-risk cohort. |
| format | Article |
| id | doaj-art-adc7a22edcf4424585487f8ea660e991 |
| institution | Kabale University |
| issn | 0022-1058 2969-8960 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | EDP Sciences |
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| series | The Journal of ExtraCorporeal Technology |
| spelling | doaj-art-adc7a22edcf4424585487f8ea660e9912025-01-08T11:00:21ZengEDP SciencesThe Journal of ExtraCorporeal Technology0022-10582969-89602024-12-0156417418410.1051/ject/2024020ject240021Determining the association of hyperoxia while on extracorporeal life support with mortality in neonates following Norwood operationBeshish Asaad G.0Aljiffry Alaa1Xiang Yijin2Evans Sean3Scheel Amy4Harriott Ashley5Patel Shayli6Amedi Alan7Harding Amanda8Davis Joel9Shashidharan Subhadra10Kwiatkowski David M.11Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of AtlantaDepartment of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of AtlantaBiostatistician and Data Analyst, Department of Pediatrics, Emory University School of MedicineEmory University School of MedicineEmory University School of MedicineEmory University School of MedicineEmory University School of MedicineEmory University School of MedicineSenior Pediatric Cardiac Sonographer, Children’s Healthcare of AtlantaAdvanced Technology Coordinator, ECMO and Advanced Technologies, Children’s Healthcare of AtlantaDepartment of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Children’s Healthcare of AtlantaDepartment of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Lucile Packard Children’s HospitalBackground: Patients requiring extracorporeal life support (ECLS) support post-Norwood operation constitute an extremely high-risk group. Materials and methods: We retrospectively aimed to evaluate the relationship of hyperoxia with mortality and other clinical outcomes in patients who required ECLS following Norwood operation between January/2010 and December/2020 in a large volume center. Results: During the study period 65 patients required ECLS post-Norwood. Using receiver operating characteristic (ROC) curve analysis, mean PaO2 of 182 mmHg in the first 48-hour on ECLS was determined to have the optimal discriminatory ability for mortality (sensitivity 68%, specificity 70%). Of the 65 patients, 52% had PaO2 > 182 mmHg and were designated as hyperoxia group. Patients in the hyperoxia-group had longer cardiopulmonary bypass time (187 vs. 165 min, p = 0.023), shorter duration from CICU arrival to ECLS-cannulation (13.28 vs. 132.58 h, p = 0.003), higher serum lactate within 2-hours from ECLS-canulation (14.55 vs. 5.80, p = 0.01), higher ECLS flows in the first 4-hours (152.68 vs. 124.14, p = 0.006), and higher mortality (77% vs. 39%, p = 0.005). In the unadjusted-analysis, using a derived cut-point, patients in the hyperoxia-group had 5.15 higher odds of mortality (p = 0.003). However, this association was insignificant when adjusting for confounding variables (p = 0.104). Using a functional status scale, new morbidity (38% vs. 21%), and unfavorable outcomes (13% vs. 5%) were higher in the hyperoxia group. Despite being higher in the hyperoxia group, this did not reach statistical significance. Conclusion: Neonates with hyperoxia (PaO2 > 182 Torr) during the first 48-hour of ECLS post-Norwood operation had 5 times higher odds of mortality in the unadjusted analysis, however, this was insignificant when adjusting for confounding variables. Patients in the hyperoxia group had shorter duration from CICU arrival to ECLS-cannulation, higher serum lactate prior to ECLS-canulation, and higher ECLS flows in the first 4-hours, (p < 0.05). Multicenter evaluation of this modifiable risk factor is imperative to improve the care of this high-risk cohort.https://ject.edpsciences.org/articles/ject/full_html/2024/04/ject240021/ject240021.htmluniventricular physiologynorwood operationextracorporeal life support (ecls)hyperoxiafunctional status scale (fss)new morbidityunfavorable outcomes |
| spellingShingle | Beshish Asaad G. Aljiffry Alaa Xiang Yijin Evans Sean Scheel Amy Harriott Ashley Patel Shayli Amedi Alan Harding Amanda Davis Joel Shashidharan Subhadra Kwiatkowski David M. Determining the association of hyperoxia while on extracorporeal life support with mortality in neonates following Norwood operation The Journal of ExtraCorporeal Technology univentricular physiology norwood operation extracorporeal life support (ecls) hyperoxia functional status scale (fss) new morbidity unfavorable outcomes |
| title | Determining the association of hyperoxia while on extracorporeal life support with mortality in neonates following Norwood operation |
| title_full | Determining the association of hyperoxia while on extracorporeal life support with mortality in neonates following Norwood operation |
| title_fullStr | Determining the association of hyperoxia while on extracorporeal life support with mortality in neonates following Norwood operation |
| title_full_unstemmed | Determining the association of hyperoxia while on extracorporeal life support with mortality in neonates following Norwood operation |
| title_short | Determining the association of hyperoxia while on extracorporeal life support with mortality in neonates following Norwood operation |
| title_sort | determining the association of hyperoxia while on extracorporeal life support with mortality in neonates following norwood operation |
| topic | univentricular physiology norwood operation extracorporeal life support (ecls) hyperoxia functional status scale (fss) new morbidity unfavorable outcomes |
| url | https://ject.edpsciences.org/articles/ject/full_html/2024/04/ject240021/ject240021.html |
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