title: Hyperoxia Is Associated With Poor Outcomes in Pediatric Cardiac Patients Supported on Venoarterial Extracorporeal Membrane Oxygenation.
abstract: OBJECTIVE
  Patients who require venoarterial extracorporeal membrane oxygenation because of cardiac failure frequently have supranormal blood oxygen tensions (hyperoxia). Recent studies have suggested worse outcomes in patients with hyperoxia after resuscitation from cardiac or respiratory arrests, presumably because of oxidative stress. There are limited data regarding the effect of hyperoxia on outcomes in pediatric patients on venoarterial extracorporeal membrane oxygenation.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Pediatric cardiothoracic ICU.
  
  
  METHODS
  Cardiac surgery patients less than 1 year old requiring venoarterial extracorporeal membrane oxygenation in the postoperative period from 2007 to 2013.
  
  
  RESULTS
  In 93 infants (median time on extracorporeal membrane oxygenation, 5 d), mortality at 30 days post surgery (primary outcome) was 38%. Using a receiver operating characteristic curve, a mean PaO2 of 193 mm Hg in the first 48 hours of extracorporeal membrane oxygenation was determined to have good discriminatory ability with regard to 30-day mortality. Univariate analysis identified a mean PaO2 greater than 193 mm Hg (p = 0.001), longer cardiopulmonary bypass times (p = 0.09), longer duration of extracorporeal membrane oxygenation (p < 0.0001), and higher extracorporeal membrane oxygenation pump flows (p = 0.052) as possible risk factors for 30-day mortality. In multivariable analysis controlling for the variables listed above, a mean PaO2 greater than 193 mm Hg remained an independent risk factor for mortality (p = 0.03). In addition, a mean PaO2 greater than 193 mm Hg was associated with the need for renal dialysis (p = 0.02) but not with neurologic injury (p = 0.41) during the hospitalization.
  
  
  CONCLUSIONS
  In infants with congenital heart disease who are placed on venoarterial extracorporeal membrane oxygenation postoperatively, hyperoxia (defined as a mean PaO2 > 193 mm Hg in the first 48 hr of extracorporeal membrane oxygenation) was an independent risk factor for 30-day mortality after surgery. Future studies are needed to delineate the causative or associative role of hyperoxia with outcomes, especially in children with baseline cyanosis who may be more susceptible to the effects of oxidative stress.
authors.affiliation: 1Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, University of Michigan, Ann Arbor, MI. 2Section of Pediatric Cardiac Surgery, Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Sznycer-Taub
authors.forename: Ray
authors.initials: R
authors.lastname: Lowery
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.forename: Sonal T
authors.initials: ST
authors.lastname: Owens
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hirsch-Romano
authors.forename: Gabe E
authors.initials: GE
authors.lastname: Owens
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D018496:Hyperoxia / Q000401:mortality*; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D015278:Intensive Care Units, Pediatric; D008297:Male; D015999:Multivariate Analysis; D018384:Oxidative Stress; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome