Hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation: Associations with complications, mortality, and functional status among survivors

Katherine Cashen, Ron Reeder, Heidi J. Dalton, Robert A. Berg, Thomas Patrick Shanley, Christopher J.L. Newth, Murray M. Pollack, David Wessel, Joseph Carcillo, Rick Harrison, J. Michael Dean, Robert Tamburro, Kathleen L. Meert*

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives: To determine the frequency of hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation and their relationships to complications, mortality, and functional status among survivors. Design: Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network. Setting: Eight Collaborative Pediatric Critical Care Research Network–affiliated hospitals. Patients: Age less than 19 years and treated with extracorporeal membrane oxygenation. Interventions: Hyperoxia was defined as highest Pao 2 greater than 200 Torr (27 kPa) and hypocapnia as lowest Paco 2 less than 30 Torr (3.9 kPa) during the first 48 hours of extracorporeal membrane oxygenation. Functional status at hospital discharge was evaluated among survivors using the Functional Status Scale. Measurements and Main Results: Of 484 patients, 420 (86.7%) had venoarterial extracorporeal membrane oxygenation and 64 (13.2%) venovenous; 69 (14.2%) had extracorporeal membrane oxygenation initiated during cardiopulmonary resuscitation. Hyperoxia occurred in 331 (68.4%) and hypocapnia in 98 (20.2%). Hyperoxic patients had higher mortality than patients without hyperoxia (167 [50.5%] vs 48 [31.4%]; p < 0.001), but no difference in functional status among survivors. Hypocapnic patients were more likely to have a neurologic event (49 [50.0%] vs 143 (37.0%]; p = 0.021) or hepatic dysfunction (49 [50.0%] vs 121 [31.3%]; p < 0.001) than patients without hypocapnia, but no difference in mortality or functional status among survivors. On multivariable analysis, factors independently associated with increased mortality included highest Pao 2 and highest blood lactate concentration in the first 48 hours of extracorporeal membrane oxygenation, congenital diaphragmatic hernia, and being a preterm neonate. Factors independently associated with lower mortality included meconium aspiration syndrome. Conclusions: Hyperoxia is common during pediatric extracorporeal membrane oxygenation and associated with mortality. Hypocapnia appears to occur less often and although associated with complications an association with mortality was not observed.

Original languageEnglish (US)
Pages (from-to)245-253
Number of pages9
JournalPediatric Critical Care Medicine
Volume19
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Hypocapnia
Extracorporeal Membrane Oxygenation
Hyperoxia
Survivors
Pediatrics
Mortality
Critical Care
Meconium Aspiration Syndrome
Cardiopulmonary Resuscitation
Research
Nervous System
Lactic Acid
Newborn Infant
Liver

Keywords

  • Child
  • Extracorporeal membrane oxygenation
  • Hyperoxia
  • Hypocapnia
  • Neonate

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Cashen, Katherine ; Reeder, Ron ; Dalton, Heidi J. ; Berg, Robert A. ; Shanley, Thomas Patrick ; Newth, Christopher J.L. ; Pollack, Murray M. ; Wessel, David ; Carcillo, Joseph ; Harrison, Rick ; Michael Dean, J. ; Tamburro, Robert ; Meert, Kathleen L. / Hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation : Associations with complications, mortality, and functional status among survivors. In: Pediatric Critical Care Medicine. 2018 ; Vol. 19, No. 3. pp. 245-253.
@article{f2d0dcd789c944578e13b0b083cc3bcb,
title = "Hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation: Associations with complications, mortality, and functional status among survivors",
abstract = "Objectives: To determine the frequency of hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation and their relationships to complications, mortality, and functional status among survivors. Design: Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network. Setting: Eight Collaborative Pediatric Critical Care Research Network–affiliated hospitals. Patients: Age less than 19 years and treated with extracorporeal membrane oxygenation. Interventions: Hyperoxia was defined as highest Pao 2 greater than 200 Torr (27 kPa) and hypocapnia as lowest Paco 2 less than 30 Torr (3.9 kPa) during the first 48 hours of extracorporeal membrane oxygenation. Functional status at hospital discharge was evaluated among survivors using the Functional Status Scale. Measurements and Main Results: Of 484 patients, 420 (86.7{\%}) had venoarterial extracorporeal membrane oxygenation and 64 (13.2{\%}) venovenous; 69 (14.2{\%}) had extracorporeal membrane oxygenation initiated during cardiopulmonary resuscitation. Hyperoxia occurred in 331 (68.4{\%}) and hypocapnia in 98 (20.2{\%}). Hyperoxic patients had higher mortality than patients without hyperoxia (167 [50.5{\%}] vs 48 [31.4{\%}]; p < 0.001), but no difference in functional status among survivors. Hypocapnic patients were more likely to have a neurologic event (49 [50.0{\%}] vs 143 (37.0{\%}]; p = 0.021) or hepatic dysfunction (49 [50.0{\%}] vs 121 [31.3{\%}]; p < 0.001) than patients without hypocapnia, but no difference in mortality or functional status among survivors. On multivariable analysis, factors independently associated with increased mortality included highest Pao 2 and highest blood lactate concentration in the first 48 hours of extracorporeal membrane oxygenation, congenital diaphragmatic hernia, and being a preterm neonate. Factors independently associated with lower mortality included meconium aspiration syndrome. Conclusions: Hyperoxia is common during pediatric extracorporeal membrane oxygenation and associated with mortality. Hypocapnia appears to occur less often and although associated with complications an association with mortality was not observed.",
keywords = "Child, Extracorporeal membrane oxygenation, Hyperoxia, Hypocapnia, Neonate",
author = "Katherine Cashen and Ron Reeder and Dalton, {Heidi J.} and Berg, {Robert A.} and Shanley, {Thomas Patrick} and Newth, {Christopher J.L.} and Pollack, {Murray M.} and David Wessel and Joseph Carcillo and Rick Harrison and {Michael Dean}, J. and Robert Tamburro and Meert, {Kathleen L.}",
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Cashen, K, Reeder, R, Dalton, HJ, Berg, RA, Shanley, TP, Newth, CJL, Pollack, MM, Wessel, D, Carcillo, J, Harrison, R, Michael Dean, J, Tamburro, R & Meert, KL 2018, 'Hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation: Associations with complications, mortality, and functional status among survivors', Pediatric Critical Care Medicine, vol. 19, no. 3, pp. 245-253. https://doi.org/10.1097/PCC.0000000000001439

Hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation : Associations with complications, mortality, and functional status among survivors. / Cashen, Katherine; Reeder, Ron; Dalton, Heidi J.; Berg, Robert A.; Shanley, Thomas Patrick; Newth, Christopher J.L.; Pollack, Murray M.; Wessel, David; Carcillo, Joseph; Harrison, Rick; Michael Dean, J.; Tamburro, Robert; Meert, Kathleen L.

In: Pediatric Critical Care Medicine, Vol. 19, No. 3, 01.03.2018, p. 245-253.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation

T2 - Associations with complications, mortality, and functional status among survivors

AU - Cashen, Katherine

AU - Reeder, Ron

AU - Dalton, Heidi J.

AU - Berg, Robert A.

AU - Shanley, Thomas Patrick

AU - Newth, Christopher J.L.

AU - Pollack, Murray M.

AU - Wessel, David

AU - Carcillo, Joseph

AU - Harrison, Rick

AU - Michael Dean, J.

AU - Tamburro, Robert

AU - Meert, Kathleen L.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Objectives: To determine the frequency of hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation and their relationships to complications, mortality, and functional status among survivors. Design: Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network. Setting: Eight Collaborative Pediatric Critical Care Research Network–affiliated hospitals. Patients: Age less than 19 years and treated with extracorporeal membrane oxygenation. Interventions: Hyperoxia was defined as highest Pao 2 greater than 200 Torr (27 kPa) and hypocapnia as lowest Paco 2 less than 30 Torr (3.9 kPa) during the first 48 hours of extracorporeal membrane oxygenation. Functional status at hospital discharge was evaluated among survivors using the Functional Status Scale. Measurements and Main Results: Of 484 patients, 420 (86.7%) had venoarterial extracorporeal membrane oxygenation and 64 (13.2%) venovenous; 69 (14.2%) had extracorporeal membrane oxygenation initiated during cardiopulmonary resuscitation. Hyperoxia occurred in 331 (68.4%) and hypocapnia in 98 (20.2%). Hyperoxic patients had higher mortality than patients without hyperoxia (167 [50.5%] vs 48 [31.4%]; p < 0.001), but no difference in functional status among survivors. Hypocapnic patients were more likely to have a neurologic event (49 [50.0%] vs 143 (37.0%]; p = 0.021) or hepatic dysfunction (49 [50.0%] vs 121 [31.3%]; p < 0.001) than patients without hypocapnia, but no difference in mortality or functional status among survivors. On multivariable analysis, factors independently associated with increased mortality included highest Pao 2 and highest blood lactate concentration in the first 48 hours of extracorporeal membrane oxygenation, congenital diaphragmatic hernia, and being a preterm neonate. Factors independently associated with lower mortality included meconium aspiration syndrome. Conclusions: Hyperoxia is common during pediatric extracorporeal membrane oxygenation and associated with mortality. Hypocapnia appears to occur less often and although associated with complications an association with mortality was not observed.

AB - Objectives: To determine the frequency of hyperoxia and hypocapnia during pediatric extracorporeal membrane oxygenation and their relationships to complications, mortality, and functional status among survivors. Design: Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network. Setting: Eight Collaborative Pediatric Critical Care Research Network–affiliated hospitals. Patients: Age less than 19 years and treated with extracorporeal membrane oxygenation. Interventions: Hyperoxia was defined as highest Pao 2 greater than 200 Torr (27 kPa) and hypocapnia as lowest Paco 2 less than 30 Torr (3.9 kPa) during the first 48 hours of extracorporeal membrane oxygenation. Functional status at hospital discharge was evaluated among survivors using the Functional Status Scale. Measurements and Main Results: Of 484 patients, 420 (86.7%) had venoarterial extracorporeal membrane oxygenation and 64 (13.2%) venovenous; 69 (14.2%) had extracorporeal membrane oxygenation initiated during cardiopulmonary resuscitation. Hyperoxia occurred in 331 (68.4%) and hypocapnia in 98 (20.2%). Hyperoxic patients had higher mortality than patients without hyperoxia (167 [50.5%] vs 48 [31.4%]; p < 0.001), but no difference in functional status among survivors. Hypocapnic patients were more likely to have a neurologic event (49 [50.0%] vs 143 (37.0%]; p = 0.021) or hepatic dysfunction (49 [50.0%] vs 121 [31.3%]; p < 0.001) than patients without hypocapnia, but no difference in mortality or functional status among survivors. On multivariable analysis, factors independently associated with increased mortality included highest Pao 2 and highest blood lactate concentration in the first 48 hours of extracorporeal membrane oxygenation, congenital diaphragmatic hernia, and being a preterm neonate. Factors independently associated with lower mortality included meconium aspiration syndrome. Conclusions: Hyperoxia is common during pediatric extracorporeal membrane oxygenation and associated with mortality. Hypocapnia appears to occur less often and although associated with complications an association with mortality was not observed.

KW - Child

KW - Extracorporeal membrane oxygenation

KW - Hyperoxia

KW - Hypocapnia

KW - Neonate

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