Duration of Hyperoxia and Neurologic Outcomes in Patients Undergoing Extracorporeal Membrane Oxygenation. Issue 10 (3rd May 2021)

• Record Type: Journal Article
• Authors: Al-Kawaz, Mais N.; Canner, Joseph; Caturegli, Giorgio; Kannapadi, Nivedha; Balucani, Clotilde; Shelley, Leah; Kim, Bo Soo; Choi, Chun Woo; Geocadin, Romergryko G.; Whitman, Glenn; Cho, Sung-Min
• Is Part Of: Critical care medicine. Volume 49:Issue 10(2021)
• Page Start: e968
• Page End: e977
• Publication Date: 2021-05-03
• Subjects: acute brain injury -- cardiac arrest -- extracorporeal oxygenation -- hyperoxia -- mortality -- neurologic outcome -- postcardiotomy shock; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000005069
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : OBJECTIVES: To evaluate the impact of duration of hyperoxia on neurologic outcome and mortality in patients undergoing venoarterial extracorporeal membrane oxygenation. DESIGN: A retrospective analysis of venoarterial extracorporeal membrane oxygenation patients admitted to the Johns Hopkins Hospital. The primary outcome was neurologic function at discharge defined by modified Rankin Scale, with a score of 0–3 defined as a good neurologic outcome, and a score of 4–6 defined as a poor neurologic outcome. Multivariable logistic regression analysis was performed to evaluate the association between hyperoxia and neurologic outcomes. SETTING: The Johns Hopkins Hospital Cardiovascular ICU and Cardiac Critical Care Unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We measured first and maximum Pao 2 values, area under the curve per minute over the first 24 hours, and duration of mild, moderate, and severe hyperoxia. Of 132 patients on venoarterial extracorporeal membrane oxygenation, 127 (96.5%) were exposed to mild hyperoxia in the first 24 hours. Poor neurologic outcomes were observed in 105 patients (79.6%) (102 with vs 3 without hyperoxia; p = 0.14). Patients with poor neurologic outcomes had longer exposure to mild (19.1 vs 15.2 hr; p = 0.01), moderate (14.6 vs 9.2 hr; p = 0.003), and severe hyperoxia (9.1 vs 4.0 hr; p = 0.003). In a multivariable analysis, patients with worse neurologic outcome experienced longer durations of mild (adjusted odds ratio, 1.10; 95% CI, 1.01–1.19; p = 0.02), moderate (adjusted odds ratio, 1.12; 95% CI, 1.04–1.22; p = 0.002), and severe (adjusted odds ratio, 1.19; 95% CI, 1.06–1.35; p = 0.003) hyperoxia. Additionally, duration of severe hyperoxia was independently associated with inhospital mortality (adjusted odds ratio, 1.18; 95% CI, 1.08–1.29; p < 0.001). CONCLUSIONS: In patients undergoing venoarterial extracorporeal membrane oxygenation, duration and severity of early hyperoxia were independently associated with poor neurologic outcomes at discharge and mortality.