Laveena Munshi1, Alex Kiss2, Marcelo Cypel3,4, Shaf Keshavjee3,4, Niall D Ferguson3, Eddy Fan4,5. 1. Interdepartmental Division of Critical Care Medicine, Department of Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada. 2. Institute for Clinical Evaluative Sciences. 3. Extracorporeal Life Support Program, Toronto General Hospital, University of Toronto, ON, Canada. 4. Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada. 5. Interdepartmental Division of Critical Care Medicine, Department of Medicine, Institute of Health Policy, Management and Evaluation, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
Abstract
OBJECTIVES: Extracorporeal life support can lead to rapid reversal of hypoxemia and shock; however, it can also result in varying degrees of hyperoxia. Recent data have suggested an association between hyperoxia and mortality; however, this conclusion has not been consistent across the literature. We evaluated the association between oxygenation thresholds and mortality in three cohorts of extracorporeal life support patients. DESIGN: We performed a retrospective cohort study using the Extracorporeal Life Support Organization Registry. SETTING: We evaluated the relationship between oxygenation measured 24 hours after extracorporeal membrane oxygenation onset and mortality (2010-2015). PATIENTS: The extracorporeal life support cohorts were as follows: 1) veno-venous extracorporeal membrane oxygenation for respiratory failure, 2) veno-arterial extracorporeal membrane oxygenation for cardiogenic shock, and 3) extracorporeal cardiopulmonary resuscitation. INTERVENTIONS: The relationships between hypoxemia (PaO2 < 60mm Hg), normoxia (PaO2 60-100mm Hg), moderate hyperoxia (PaO2 101-300mm Hg), extreme hyperoxia (PaO2 > 300 mm Hg), and mortality were evaluated across three extracorporeal life support cohorts. MEASUREMENTS AND MAIN RESULTS: Seven hundred sixty-five patients underwent veno-venous extracorporeal membrane oxygenation, 775 patients underwent veno-arterial extracorporeal membrane oxygenation, and 412 underwent extracorporeal cardiopulmonary resuscitation. During veno-venous extracorporeal membrane oxygenation, hypoxemia (odds ratio, 1.68; 95% CI, 1.09-2.57) and moderate hyperoxia (odds ratio, 1.66; 95% CI, 1.11-2.50) were associated with increased mortality compared with normoxia. There was no association between oxygenation and mortality for veno-arterial extracorporeal membrane oxygenation. Moderate hyperoxia was associated with increased mortality during extracorporeal cardiopulmonary resuscitation compared with normoxia (odds ratio, 1.77; 95% CI, 1.03-3.30). An exploratory analysis did not find more specific PaO2 thresholds associated with mortality within moderate hyperoxia. CONCLUSIONS: Moderate hyperoxia was associated with increased mortality in patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure and extracorporeal cardiopulmonary resuscitation. Hypoxemia was associated with an increased mortality in veno-venous extracorporeal membrane oxygenation. No association was seen between oxygenation and mortality in veno-arterial extracorporeal membrane oxygenation which may be due to early death driven by the underlying disease.
OBJECTIVES: Extracorporeal life support can lead to rapid reversal of hypoxemia and shock; however, it can also result in varying degrees of hyperoxia. Recent data have suggested an association between hyperoxia and mortality; however, this conclusion has not been consistent across the literature. We evaluated the association between oxygenation thresholds and mortality in three cohorts of extracorporeal life support patients. DESIGN: We performed a retrospective cohort study using the Extracorporeal Life Support Organization Registry. SETTING: We evaluated the relationship between oxygenation measured 24 hours after extracorporeal membrane oxygenation onset and mortality (2010-2015). PATIENTS: The extracorporeal life support cohorts were as follows: 1) veno-venous extracorporeal membrane oxygenation for respiratory failure, 2) veno-arterial extracorporeal membrane oxygenation for cardiogenic shock, and 3) extracorporeal cardiopulmonary resuscitation. INTERVENTIONS: The relationships between hypoxemia (PaO2 < 60mm Hg), normoxia (PaO2 60-100mm Hg), moderate hyperoxia (PaO2 101-300mm Hg), extreme hyperoxia (PaO2 > 300 mm Hg), and mortality were evaluated across three extracorporeal life support cohorts. MEASUREMENTS AND MAIN RESULTS: Seven hundred sixty-five patients underwent veno-venous extracorporeal membrane oxygenation, 775 patients underwent veno-arterial extracorporeal membrane oxygenation, and 412 underwent extracorporeal cardiopulmonary resuscitation. During veno-venous extracorporeal membrane oxygenation, hypoxemia (odds ratio, 1.68; 95% CI, 1.09-2.57) and moderate hyperoxia (odds ratio, 1.66; 95% CI, 1.11-2.50) were associated with increased mortality compared with normoxia. There was no association between oxygenation and mortality for veno-arterial extracorporeal membrane oxygenation. Moderate hyperoxia was associated with increased mortality during extracorporeal cardiopulmonary resuscitation compared with normoxia (odds ratio, 1.77; 95% CI, 1.03-3.30). An exploratory analysis did not find more specific PaO2 thresholds associated with mortality within moderate hyperoxia. CONCLUSIONS: Moderate hyperoxia was associated with increased mortality in patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure and extracorporeal cardiopulmonary resuscitation. Hypoxemia was associated with an increased mortality in veno-venous extracorporeal membrane oxygenation. No association was seen between oxygenation and mortality in veno-arterial extracorporeal membrane oxygenation which may be due to early death driven by the underlying disease.
Authors: Arne Diehl; Aidan J C Burrell; Andrew A Udy; Peta M A Alexander; Peter T Rycus; Ryan P Barbaro; Vincent A Pellegrino; David V Pilcher Journal: Crit Care Med Date: 2020-07 Impact factor: 7.598
Authors: Alexander Thomas; Sean van Diepen; Rachel Beekman; Shashank S Sinha; Samuel B Brusca; Carlos L Alviar; Jacob Jentzer; Erin A Bohula; Jason N Katz; Andi Shahu; Christopher Barnett; David A Morrow; Emily J Gilmore; Michael A Solomon; P Elliott Miller Journal: JACC Adv Date: 2022-08-26
Authors: Katherine Cashen; Ron Reeder; Heidi J Dalton; Robert A Berg; Thomas P Shanley; Christopher J L Newth; Murray M Pollack; David Wessel; Joseph Carcillo; Rick Harrison; J Michael Dean; Robert Tamburro; Kathleen L Meert Journal: Pediatr Crit Care Med Date: 2018-03 Impact factor: 3.624
Authors: Alexander Sacha C Richardson; Joseph E Tonna; Vinodh Nanjayya; Paul Nixon; Darryl C Abrams; Lakshmi Raman; Stephen Bernard; Simon J Finney; Brian Grunau; Scott T Youngquist; Stephen H McKellar; Zachary Shinar; Jason A Bartos; Lance B Becker; Demetris Yannopoulos; Jan Bˇelohlávek; Lionel Lamhaut; Vincent Pellegrino Journal: ASAIO J Date: 2021-03-01 Impact factor: 3.826