Hyperoxia Is Associated With Poor Outcomes in Pediatric Cardiac Patients Supported on Venoarterial Extracorporeal Membrane Oxygenation*

Abstract

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.

Conservative versus liberal oxygenation targets in critically ill children: the randomised multiple-centre pilot Oxy-PICU trial

“…We previously described supraphysiological levels of oxygenation as the norm on PICU; around one third of all recorded SpO2 values are 100% and more than 60% of values were over 95%. [8] Associations between high levels of arterial oxygenation and worse outcomes have been described postcardiac arrest, [9,10] during extra-corporeal oxygenation for congenital heart disease, [11] following stroke, [12] and in respiratory failure. [13] When added to the known risks of severe hypoxia, an 'U-shaped' relationship between arterial oxygenation and risk of death emerges.…”

What is new in pediatric ECMO? 2016, a year in review

“…In SV patients palliated via the hybrid procedure, incidence of ECMO was found to be significantly lower than following the Norwood procedure in a retrospective single‐center review of 181 hybrid procedures, but mortality was higher . In another retrospective study of 93 infants post cardiac surgery (median age 7 days), a partial pressure of oxygen above 193 mmHg was an independent risk factor for mortality . The authors speculate that hyperoxia might be harmful because of the generation of reactive oxygen species leading to increased oxidative stress and cellular damage and an exaggerated inflammatory and thrombotic cascade.…”

“…The authors speculate that hyperoxia might be harmful because of the generation of reactive oxygen species leading to increased oxidative stress and cellular damage and an exaggerated inflammatory and thrombotic cascade. They suggest future prospective studies are necessary to investigate the effect of hyperoxia while on ECMO, but also that a change of practice in management of these patients in many centers might be prudent …”

Oxygen

“…Recent studies on potential toxic effects of oxygen due to hyperoxemia after ischemia reperfusion have reinvigorated the interest in this aspect of patient management and created controversy. In this issue of the journal, Sznycer-Taub et al, report their findings on the topic of hyperoxia in infants with congenital heart disease who are placed on VA-ECMO in the post-operative setting (4). Sznycer-Taub and colleagues’ study is the first report on this topic in patients supported on ECMO.…”