Hyperoxia During Neonatal Cardiopulmonary Bypass Is Associated With Worse Clinical Outcomes: A Multi-Institutional Study.
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Beshish Asaad G, Kwiatkowski David M, Sznycer-Taub Nathaniel, Costello John M, Jergel Andrew, Gillespie Scott, Cashen Katherine, Asfari Ahmed, Batsis Maria, Buckley Jason R, Chlebowski Meghan M, Flores Saul, Goldshtrom Nimrod, Migally Karl, Mills Kimberly I, Radman Monique R, Reddy Chetana, Shutes Brittany, Riley Christine M, Narasimhulu Sukumar S, Mueller Dana, Amula Venugopal, Venkitachalam Raji, Joy Brian F, Karki Karan B, Leopold Scott M, Schramm Jennifer E, Capone Christine A, Aydin Scott I, Bakar Adnan M, Leong Kieran, Kulikowska Agnieszka, Wing Sarah, Mastropietro Christopher W, Collaborative Research from the Pediatric Intensive Care Society (CoRe‐PCICS) Investigators
Аннотация
METHODS: We conducted a retrospective study of neonates who underwent surgery with CPB between January 2021 and December 2022 at 29 centers. Primary outcomes were operative mortality and major adverse cardiovascular events, which included cardiopulmonary resuscitation, extracorporeal support, stroke, and mortality. Logistic regression assessed the associations between median partial pressure of oxygen in arterial blood (PaO2) during CPB and outcomes in the entire cohort and subset of patients with single-ventricle (SV) anatomy.
RESULTS: We analyzed 1175 neonates, including 357 with SV anatomy. Median PaO2 during CPB was 296 mm Hg (range: 54-800), with significant variation across centers (P<0.001). There were 54 deaths (5%) and 203 major adverse cardiovascular events (17%). No patients with PaO2 <200 mm Hg (n=161) died, and PaO2 >221 mm Hg demonstrated modest mortality prediction (96% sensitivity, 19% specificity). In multivariable analysis, before adjustment for center, PaO2 >221 mm Hg was significantly associated with mortality and major adverse cardiovascular events in all patients and patients with SV anatomy. After adjustment for center, associations between hyperoxia and mortality (P=0.053) or major adverse cardiovascular events (P=0.08) were not significant in the entire cohort but remained significant in patients with SV anatomy.
CONCLUSIONS: We observed significant variation in oxygen exposure during neonatal CPB across centers and significant associations between hyperoxia and worse outcomes, particularly in neonates with SV anatomy.