Hyperoxia During Neonatal Cardiopulmonary Bypass Is Associated With Worse Clinical Outcomes: A Multi‐Institutional Study
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background Exposure to supraphysiologic oxygen concentrations, or hyperoxia, during neonatal cardiopulmonary bypass (CPB) has been associated with worse outcomes in single‐center studies. We aimed to describe variation in oxygen exposure during CPB and determine if hyperoxia is associated with worse outcomes in a multicenter cohort of neonates undergoing cardiac surgery. Methods We conducted a retrospective study of neonates who underwent surgery with CPB between January 2021 and December 2022 at 29 centers. Primary outcomes were operative mortality and major adverse cardiovascular events, which included cardiopulmonary resuscitation, extracorporeal support, stroke, and mortality. Logistic regression assessed the associations between median partial pressure of oxygen in arterial blood (PaO 2 ) during CPB and outcomes in the entire cohort and subset of patients with single‐ventricle (SV) anatomy. Results We analyzed 1175 neonates, including 357 with SV anatomy. Median PaO 2 during CPB was 296 mm Hg (range: 54–800), with significant variation across centers ( P <0.001). There were 54 deaths (5%) and 203 major adverse cardiovascular events (17%). No patients with PaO 2 <200 mm Hg (n=161) died, and PaO 2 >221 mm Hg demonstrated modest mortality prediction (96% sensitivity, 19% specificity). In multivariable analysis, before adjustment for center, PaO 2 >221 mm Hg was significantly associated with mortality and major adverse cardiovascular events in all patients and patients with SV anatomy. After adjustment for center, associations between hyperoxia and mortality ( P =0.053) or major adverse cardiovascular events ( P =0.08) were not significant in the entire cohort but remained significant in patients with SV anatomy. Conclusions We observed significant variation in oxygen exposure during neonatal CPB across centers and significant associations between hyperoxia and worse outcomes, particularly in neonates with SV anatomy.
Authors: Asaad G. Beshish, David M. Kwiatkowski, Nathaniel Sznycer‐Taub, John M. Costello, Andrew Jergel, Scott Gillespie, Katherine Cashen, Ahmed Asfari, Maria Batsis, Jason R. Buckley, Meghan M. Chlebowski, Saul Flores, Nimrod Goldshtrom, Karl Migally, Kimberly I. Mills, Monique R. Radman, Chetana Reddy, Brittany Shutes, Christine M. Riley, Sukumar S. Narasimhulu, Dana Mueller, Venugopal Amula, Raji Venkitachalam, Brian F. Joy, Karan B. Karki, Scott M. Leopold, Jennifer E. Schramm, Christine A. Capone, Scott I. Aydin, Adnan M. Bakar, Kieran Leong, Agnieszka Kulikowska, Sarah Wing, Christopher W. Mastropietro
Institutions: Emory University, Children's Healthcare of Atlanta, Lucile Packard Children's Hospital, Stanford University, University of Michigan, Medical University of South Carolina, Duke University, Duke Medical Center, Duke University Health System, University of Alabama at Birmingham, UAB Medicine, The University of Texas Southwestern Medical Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Baylor College of Medicine, Texas Children's Hospital, Columbia University Irving Medical Center, Columbia University, Northwestern University, Lurie Children's Hospital, Boston Children's Hospital, Harvard University, Seattle Children's Hospital, University of Washington, Cardinal Glennon Children’s Medical Center, Saint Louis University, Nationwide Children's Hospital, The Ohio State University, Children's National, University of Florida Health, University of Florida, University of California San Diego, Rady Children's Hospital-San Diego, Intermountain Healthcare, Primary Children's Hospital, University of Utah, Medical College of Wisconsin, University of Minnesota, Fairview Health Services, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, University of Wisconsin American Family Children's Hospital, Johns Hopkins University, Johns Hopkins Medicine, Cohen Children's Medical Center, Icahn School of Medicine at Mount Sinai, Albany Medical Center Hospital, University of North Carolina at Chapel Hill, OSF HealthCare, Children's Hospital of Illinois, Riley Hospital for Children, Indiana University School of Medicine
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,810
OpenAlex ID: W4416045732