Is hyperoxia in early pediatric veno-veno extracorporeal life support associated with mortality?

Abstract

Background: Data is limited regarding the effects of supraphysiologic blood oxygen tension (hyperoxia) in patients requiring extracorporeal life support (ECLS). We sought to evaluate the association between hyperoxia and outcomes in pediatric patients requiring veno-venous (VV) ECLS.

Methods: Retrospective single-center study at an academic children's hospital, Children's Healthcare of Atlanta, Emory University School of Medicine that included all patients 0-18 years who required VV-ECLS between 01/2014 and 12/2019.

Results: During the study period 110 VV-ECLS runs occurred in 110 patients. Using a receiver operating characteristic curve, a mean partial pressures of oxygen (PaO₂) of 122 mmHg in the first 48 hours of ECLS was determined to have the optimal discriminatory ability with regard to mortality (sensitivity 41% and specificity 86%). Of the VV-ECLS runs, 68 (61.8%) had PaO₂ > 122 mmHg (hyperoxia group). The hyperoxia group tended to be older (105.4 vs. 1.6 months, p = 0.001), had higher rates of hemorrhagic complications (69.6% vs. 25.3%, p = 0.0001), and higher mortality rate (57.9% vs. 19.5%, p = 0.002). Adjusting for confounders, the hyperoxia group had higher odds of mortality (OR: 7.97, 95% CI: 1.72-36.86, p = 0.0079).

Conclusion: Children exposed to hyperoxia during the first 48 h of VV-ECLS were 8 times more likely to die than those who were not after adjusting for confounders (age group, body surface area, and indication for ECLS). Multicenter and prospective evaluation of this modifiable risk factor is imperative to improving the care of this high-risk cohort.