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 P.
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.
N1 - Funding Information:
All authors received support for article research from the National Institutes of Health (NIH). Drs. Reeder’s, Berg’s, Shanley’s, Newth’s, Pollack’s, and Carcillo’s institutions received funding from the National Institute of Child Health and Human Development. Drs. Dalton’s, Wessel’s, Harrison’s, Dean’s, and Meert’s institutions received funding from the NIH. Dr. Dalton Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
Funding Information:
received funding from Maquet and Innovative extracorporeal membrane oxygenation (ECMO) Concepts, and she disclosed off-label product use of ECMO. Dr. Shanley received funding from Springer Publishing, International Pediatric Research Foundation (travel support for biannual meeting), and Raynes McCarty Law Firm. Dr. Newth received funding from Philips Research North America and Covidien. Dr. Tamburro received funding from Springer Publishing; he disclosed government work; and he disclosed receiving grant support from the U.S. Food and Drug Administration Office of Orphan Product Development to study the use of exogenous surfactant in acute lung injury among pediatric hematopoietic cell patients; Ony, Inc. provided the medication free of charge for that trial. For information regarding this article, E-mail: kmeert@med.wayne.edu
Funding Information:
Supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services: U10HD050096, U10HD049981, U10HD049983, U10HD050012, U10HD063108, U10HD063106, U10HD063114, and U01HD049934.
Funding Information:
Supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services: U10HD050096, U10HD049981, U10HD049983, U10HD050012, U10HD063108, U10HD063106, U10HD063114, and U01HD049934. All authors received support for article research from the National Institutes of Health (NIH). Drs. Reeder?s, Berg?s, Shanley?s, Newth?s, Pollack?s, and Carcillo?s institutions received funding from the National Institute of Child Health and Human Development. Drs. Dalton?s, Wessel?s, Harrison?s, Dean?s, and Meert?s institutions received funding from the NIH. Dr. Dalton We acknowledge the contributions of the following research coordinators and data coordinating center staff: Stephanie Bisping, BSN, RN, CCRP, Alecia Peterson, BS, and Jeri Burr, MS, RN-BC, CCRC, University of Utah; Mary Ann DiLiberto, BS, RN, CCRC and Carol Ann Twelves, BS, RN, The Children?s Hospital of Philadelphia; Jean Reardon, MA, BSN, RN and Elyse Tomanio, BSN, RN, Children?s National Medical Center; Aimee Labell, MS, RN, Phoenix Children?s Hospital; Margaret March 2018 ? Volume 19 ? Number 3 Villa, RN and Jeni Kwok, JD, Children?s Hospital Los Angeles; Mary Ann Nyc, BS, UCLA Mattel Children?s Hospital; Ann Pawluszka, BSN, RN and Melanie Lulic, BS, Children?s Hospital of Michigan; Monica S. Weber, RN, BSN, CCRP and Lauren Conlin, BSN, RN, CCRP, University of Michigan; Alan C. Abraham, BA, CCRC, University of Pittsburgh Medical Center; and Tammara Jenkins, MSN, RN, from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.
Publisher Copyright:
Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
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.
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U2 - 10.1097/PCC.0000000000001439
DO - 10.1097/PCC.0000000000001439
M3 - Article
C2 - 29319634
AN - SCOPUS:85044261876
VL - 19
SP - 245
EP - 253
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 3
ER -