TY - JOUR
T1 - Hyperoxia During Neonatal Cardiopulmonary Bypass Is Associated With Worse Clinical Outcomes
T2 - A Multi-Institutional Study
AU - the Collaborative Research from the Pediatric Intensive Care Society (CoRe-PCICS) Investigators
AU - Beshish, Asaad G.
AU - Kwiatkowski, David M.
AU - Sznycer-Taub, Nathaniel
AU - Costello, John M.
AU - Jergel, Andrew
AU - Gillespie, Scott
AU - Cashen, Katherine
AU - Asfari, Ahmed
AU - Batsis, Maria
AU - Buckley, Jason R.
AU - Chlebowski, Meghan M.
AU - Flores, Saul
AU - Goldshtrom, Nimrod
AU - Migally, Karl
AU - Mills, Kimberly I.
AU - Radman, Monique R.
AU - Reddy, Chetana
AU - Shutes, Brittany
AU - Riley, Christine M.
AU - Narasimhulu, Sukumar S.
AU - Mueller, Dana
AU - Amula, Venugopal
AU - Venkitachalam, Raji
AU - Joy, Brian F.
AU - Karki, Karan B.
AU - Leopold, Scott M.
AU - Schramm, Jennifer E.
AU - Capone, Christine A.
AU - Aydin, Scott I.
AU - Bakar, Adnan M.
AU - Leong, Kieran
AU - Kulikowska, Agnieszka
AU - Wing, Sarah
AU - Mastropietro, Christopher W.
N1 - Publisher Copyright:
© 2025 The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. JAHA is available at: www.ahajournals.org/journal/jaha
PY - 2025/11/8
Y1 - 2025/11/8
N2 - 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 (PaO2) 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 PaO2 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 PaO2 <200 mm Hg (n=161) died, and PaO2 >221 mm Hg demonstrated modest mortality prediction (96% sensitivity, 19% specificity). In multivariable analysis, before adjustment for center, PaO2 >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.
AB - 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 (PaO2) 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 PaO2 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 PaO2 <200 mm Hg (n=161) died, and PaO2 >221 mm Hg demonstrated modest mortality prediction (96% sensitivity, 19% specificity). In multivariable analysis, before adjustment for center, PaO2 >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.
KW - cardiopulmonary bypass
KW - heart defects, congenital
KW - hospital mortality
KW - hyperoxia
KW - infant, newborn
KW - oxygen
UR - https://www.scopus.com/pages/publications/105026548469
UR - https://www.scopus.com/pages/publications/105026548469#tab=citedBy
U2 - 10.1161/JAHA.125.045890
DO - 10.1161/JAHA.125.045890
M3 - Article
C2 - 41205226
AN - SCOPUS:105026548469
SN - 2047-9980
VL - 15
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 1
M1 - e045890
ER -