Hyperoxia During Neonatal Cardiopulmonary Bypass Is Associated With Worse Clinical Outcomes: A Multi-Institutional...

Area of Science:

• Cardiology
• Neonatal Medicine
• Critical Care Medicine

Background:

• Neonatal cardiopulmonary bypass (CPB) involves exposure to supraphysiologic oxygen concentrations (hyperoxia).
• Previous single-center studies suggest hyperoxia is linked to adverse outcomes in neonates undergoing cardiac surgery.
• Multicenter data is needed to confirm these associations and understand oxygen exposure variability.

Purpose of the Study:

• To quantify variations in oxygen exposure during neonatal CPB across multiple centers.
• To investigate the association between hyperoxia during CPB and adverse outcomes in neonates.
• To specifically examine outcomes in neonates with single-ventricle (SV) anatomy.

Main Methods:

• Retrospective analysis of 1175 neonates undergoing CPB between January 2021 and December 2022 across 29 centers.
• Primary outcomes included operative mortality and major adverse cardiovascular events (MACE).
• Logistic regression was used to assess the relationship between median PaO2 during CPB and outcomes, with and without center adjustment.

Main Results:

• Median PaO2 during CPB was 296 mm Hg, with significant inter-center variation (P<0.001).
• Hyperoxia (PaO2 >221 mm Hg) was associated with increased mortality and MACE before center adjustment, particularly in SV patients.
• After center adjustment, the association between hyperoxia and mortality/MACE was not significant in the overall cohort but remained significant for SV patients.

Conclusions:

• Significant variability in oxygen exposure exists during neonatal CPB across different institutions.
• Hyperoxia during CPB is associated with worse outcomes, especially in neonates with single-ventricle anatomy.
• Optimizing oxygen management during neonatal CPB is crucial, particularly for high-risk patient groups.