Reducing Hyperoxia Exposure in Infants Requiring Veno-Arterial Extracorporeal Membrane Oxygenation after Cardiac Surgery

• Published in: Pediatric cardiology Vol. 45; no. 1; pp. 143 - 149
• Main Authors: Sznycer-Taub, Nathaniel R., Lowery, Ray, Yu, Sunkyung, Owens, Gabe, Charpie, John R.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2024
• Subjects: Cardiac Surgery; Cardiac Surgical Procedures - adverse effects; Cardiology; Extracorporeal Membrane Oxygenation - methods; Humans; Hyperoxia - etiology; Infant; Medicine; Medicine & Public Health; Oxygen; Thoracic Surgery; Vascular Surgery; Heart defects; Cardiothoracic surgery; Extracorporeal Membrane Oxygenation; Congenital; Hyperoxia
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s00246-023-03277-9

Recent studies have suggested worse outcomes in patients exposed to hyperoxia while supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, there are no data regarding the effect of reducing hyperoxia exposure in this population by adjusting the fraction of inspired oxygen (FiO 2 ) of the sweep gas of the ECMO circuit. A retrospective review of 143 patients less than 1 year of age requiring VA-ECMO following cardiac surgery from 2007 to 2018 was completed. 64 patients had a FiO 2 of the sweep gas < 100% with an average PaO 2 of 210 mm Hg in the first 48 h of support [vs 405 mm Hg in the group with a FiO 2  = 100% (p < 0.0001)]. There was no difference in mortality at 30 days after surgery or other markers of end-organ injury with respect to whether the FiO 2 was adjusted. At least one PaO 2 value < 200 mm Hg in the first 24 h on ECMO in patients with a FiO 2  < 100% trended toward a significant association (OR = 0.45, 95% CI = 0.21–1.01) with decreased risk of 30-day mortality when compared to those patients with a FiO 2  = 100% and all PaO 2 values > 200 mm Hg. Only 47% of patients with a FiO 2  < 100% had an average PaO 2 less than 200 mm Hg which indicates that the intervention of reducing the FiO 2 of the sweep gas was not entirely effective at reducing hyperoxia exposure. Future research is needed for developing clinical protocols to avoid hyperoxia and to identify mechanisms for hyperoxia-induced injury on VA-ECMO.