Beshish Asaad G, Aljiffry Alaa, Xiang Yijin, Evans Sean, Scheel Amy, Harriott Ashley, Patel Shayli, Amedi Alan, Harding Amanda, Davis Joel, Shashidharan Subhadra, Kwiatkowski David M
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Biostatistician and Data Analyst, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
J Extra Corpor Technol. 2024 Dec;56(4):174-184. doi: 10.1051/ject/2024020. Epub 2024 Dec 20.
Patients requiring extracorporeal life support (ECLS) support post-Norwood operation constitute an extremely high-risk group.
We retrospectively aimed to evaluate the relationship of hyperoxia with mortality and other clinical outcomes in patients who required ECLS following Norwood operation between January/2010 and December/2020 in a large volume center.
During the study period 65 patients required ECLS post-Norwood. Using receiver operating characteristic (ROC) curve analysis, mean PaO of 182 mmHg in the first 48-hour on ECLS was determined to have the optimal discriminatory ability for mortality (sensitivity 68%, specificity 70%). Of the 65 patients, 52% had PaO > 182 mmHg and were designated as hyperoxia group. Patients in the hyperoxia-group had longer cardiopulmonary bypass time (187 vs. 165 min, p = 0.023), shorter duration from CICU arrival to ECLS-cannulation (13.28 vs. 132.58 h, p = 0.003), higher serum lactate within 2-hours from ECLS-canulation (14.55 vs. 5.80, p = 0.01), higher ECLS flows in the first 4-hours (152.68 vs. 124.14, p = 0.006), and higher mortality (77% vs. 39%, p = 0.005). In the unadjusted-analysis, using a derived cut-point, patients in the hyperoxia-group had 5.15 higher odds of mortality (p = 0.003). However, this association was insignificant when adjusting for confounding variables (p = 0.104). Using a functional status scale, new morbidity (38% vs. 21%), and unfavorable outcomes (13% vs. 5%) were higher in the hyperoxia group. Despite being higher in the hyperoxia group, this did not reach statistical significance.
Neonates with hyperoxia (PaO > 182 Torr) during the first 48-hour of ECLS post-Norwood operation had 5 times higher odds of mortality in the unadjusted analysis, however, this was insignificant when adjusting for confounding variables. Patients in the hyperoxia group had shorter duration from CICU arrival to ECLS-cannulation, higher serum lactate prior to ECLS-canulation, and higher ECLS flows in the first 4-hours, (p < 0.05). Multicenter evaluation of this modifiable risk factor is imperative to improve the care of this high-risk cohort.
诺伍德手术后需要体外生命支持（ECLS）的患者构成了一个极高风险的群体。
我们回顾性地评估了2010年1月至2020年12月期间在一个大容量中心接受诺伍德手术后需要ECLS的患者中，高氧与死亡率及其他临床结局之间的关系。
在研究期间，65例患者在诺伍德手术后需要ECLS。通过受试者操作特征（ROC）曲线分析，确定ECLS开始后最初48小时内平均动脉血氧分压（PaO）为182mmHg时对死亡率具有最佳的辨别能力（敏感性68%，特异性70%）。在这65例患者中，52%的患者PaO>182mmHg，被指定为高氧组。高氧组患者的体外循环时间更长（187分钟对165分钟，p=0.023），从心脏重症监护病房（CICU）入院到ECLS插管的时间更短（13.28小时对132.58小时，p=0.003），ECLS插管后2小时内血清乳酸水平更高（14.55对5.80，p=0.01），最初4小时内ECLS流量更高（152.68对124.14，p=0.006），死亡率更高（77%对39%，p=0.005）。在未调整分析中，使用推导的切点，高氧组患者的死亡几率高5.15倍（p=0.003）。然而，在调整混杂变量后，这种关联无统计学意义（p=0.104）。使用功能状态量表，高氧组的新发病例（38%对21%）和不良结局（13%对5%）更高。尽管高氧组更高，但未达到统计学意义。
在诺伍德手术后ECLS的最初48小时内出现高氧（PaO>182托）的新生儿在未调整分析中死亡几率高5倍，然而，在调整混杂变量后无统计学意义。高氧组患者从CICU入院到ECLS插管的时间更短，ECLS插管前血清乳酸水平更高，最初4小时内ECLS流量更高（p<0.05）。对这个可改变的风险因素进行多中心评估对于改善这个高风险队列的护理至关重要。
