Abstract 4358117: Hyperoxia During Cardiopulmonary Bypass in Neonatal Congenital Heart Surgery is Associated with Worse Clinical Outcomes: A Multi-Institutional Study

Background: Neonates undergoing cardiac surgery with cardiopulmonary bypass (CPB) may be exposed to supraphysiologic oxygen (O 2 ) concentrations, termed hyperoxia, which has been associated with worse outcomes in single center studies. We aimed to describe variation in oxygen exposure during CPB within and across centers and determine if hyperoxia was associated with worse outcomes in a multicenter cohort of neonates undergoing cardiac surgery. Methods: We performed a retrospective study across 29 centers enrolled in CoRe-PCICS: Collaborative Research from the Pediatric Cardiac Intensive Care Society. Neonates (< 30d) who underwent Society of Thoracic Surgery STAT category 2–5 surgery with CPB between 01/2021 and 12/2022 were included. Clinical outcomes of interest were operative mortality and the composite outcome of major adverse cardiovascular events (MACE), including: cardiac arrest, extracorporeal support, stroke, and operative mortality. Logistic regression was performed to determine association between median PaO 2 during CPB and outcomes. Post-hoc subset analyses were performed on neonates with single ventricle (SV) anatomy. Results: We reviewed 1,175 neonates (median 48 per center), including 357 with SV anatomy. Variation in O 2 exposure during CPB is shown in Figure 1. There were 54 mortalities (5%) (Figure 2) and 203 MACE (17%) in total and 35 mortalities (10%) and 111 MACE (31%) in patients with SV anatomy. We observed no mortalities in neonates with median PaO 2 < 200mmHg (n=161). Analysis identified a median PaO 2 cut point of 221 mmHg as having modest predictive value for mortality (96% sensitivity, 19% specificity, Youden’s index score 0.16). In multivariate regression, hyperoxia (median PaO 2 > 221mmHg) was associated with mortality and MACE, controlling for birth weight, ventricular anatomy, non-cardiac anomalies, and CPB duration, however, not associated when also controlling for center. In a similar model among neonates with SV anatomy, hyperoxia was associated with mortality ( p =0.022) and MACE (p=0.008) (Table 1). Conclusions: In a multicenter study of neonates who underwent cardiac surgery, variation of O 2 exposure during CPB was apparent within and across centers and supraphysiologic PaO 2 values were common. Hyperoxia was associated with worse morbidity and mortality, particularly in neonates with SV anatomy. These findings underscore the need for a trial to determine if conservative oxygen titration during CPB leads to improved outcomes.

Authors

Institutions

Publication Details

Journal
Circulation
Published
2025-11-03
DOI
https://doi.org/10.1161/circ.152.suppl_3.4358117
Citations
1
Primary Topic
Cardiac and Coronary Surgery Techniques
Type
article
Field-Weighted Citation Impact
2.01
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Abstract 4358117: Hyperoxia During Cardiopulmonary Bypass in Neonatal Congenital Heart Surgery is Associated with Worse Clinical Outcomes: A Multi-Institutional Study

Christine M. Riley, Meghan Chlebowski, Agnieszka Kulikowska, Asaad G. Beshish et al.
1 citations
Circulation
Cardiac and Coronary Surgery Techniques
2.01
article

Abstract 4358117: Hyperoxia During Cardiopulmonary Bypass in Neonatal Congenital Heart Surgery is Associated with Worse Clinical Outcomes: A Multi-Institutional Study

Christine M. Riley, Meghan Chlebowski, Agnieszka Kulikowska, Asaad G. Beshish, Sukumar Suguna Narasimhulu, Nimrod Goldshtrom, Christopher W. Mastropietro, Katherine Cashen, Karl Migally, Monique R. Radman, David M. Kwiatkowski, Venugopal Amula, Raji Venkitachalam, Saúl Flores, Dana Mueller, Scott Leopold, Kieran Leong, Brian F. Joy, Adnan Bakar, Jennifer E. Schramm, Chetana Reddy, Jason R. Buckley, Kimberly I. Mills, Christine A. Capone, Maria Batsis, Karan B. Karki, Brittany L. Shutes, Ahmed Asfari, Scott I. Aydin, Nathaniel Sznycer‐Taub, Andrew Jergel, John Costello, Scott Gillespie
article en
1 citations

Abstract

Background: Neonates undergoing cardiac surgery with cardiopulmonary bypass (CPB) may be exposed to supraphysiologic oxygen (O 2 ) concentrations, termed hyperoxia, which has been associated with worse outcomes in single center studies. We aimed to describe variation in oxygen exposure during CPB within and across centers and determine if hyperoxia was associated with worse outcomes in a multicenter cohort of neonates undergoing cardiac surgery. Methods: We performed a retrospective study across 29 centers enrolled in CoRe-PCICS: Collaborative Research from the Pediatric Cardiac Intensive Care Society. Neonates (< 30d) who underwent Society of Thoracic Surgery STAT category 2–5 surgery with CPB between 01/2021 and 12/2022 were included. Clinical outcomes of interest were operative mortality and the composite outcome of major adverse cardiovascular events (MACE), including: cardiac arrest, extracorporeal support, stroke, and operative mortality. Logistic regression was performed to determine association between median PaO 2 during CPB and outcomes. Post-hoc subset analyses were performed on neonates with single ventricle (SV) anatomy. Results: We reviewed 1,175 neonates (median 48 per center), including 357 with SV anatomy. Variation in O 2 exposure during CPB is shown in Figure 1. There were 54 mortalities (5%) (Figure 2) and 203 MACE (17%) in total and 35 mortalities (10%) and 111 MACE (31%) in patients with SV anatomy. We observed no mortalities in neonates with median PaO 2 < 200mmHg (n=161). Analysis identified a median PaO 2 cut point of 221 mmHg as having modest predictive value for mortality (96% sensitivity, 19% specificity, Youden’s index score 0.16). In multivariate regression, hyperoxia (median PaO 2 > 221mmHg) was associated with mortality and MACE, controlling for birth weight, ventricular anatomy, non-cardiac anomalies, and CPB duration, however, not associated when also controlling for center. In a similar model among neonates with SV anatomy, hyperoxia was associated with mortality ( p =0.022) and MACE (p=0.008) (Table 1). Conclusions: In a multicenter study of neonates who underwent cardiac surgery, variation of O 2 exposure during CPB was apparent within and across centers and supraphysiologic PaO 2 values were common. Hyperoxia was associated with worse morbidity and mortality, particularly in neonates with SV anatomy. These findings underscore the need for a trial to determine if conservative oxygen titration during CPB leads to improved outcomes.

CirculationVol. 152(Suppl_3)
University of North Carolina at Chapel Hill (US), Cincinnati Children's Hospital Medical Center (US), Boston Children's Hospital (US), Seattle Children's Hospital (US), Nationwide Children's Hospital (US), Lucile Packard Children's Hospital (US), UF Health Shands Hospital (US), University of Wisconsin–Madison (US), Hofstra University (US), Johns Hopkins University (US), Emory University (US), Medical University of South Carolina (US), University of Tennessee Health Science Center (US), Duke University (US), Medical College of Wisconsin (US), University of Utah (US), Columbia University Irving Medical Center (US), University of Alabama at Birmingham (US), National Hospital (IN), Rady Children's Hospital-San Diego (US), Michigan United (US), Lurie Children's Hospital (US), University of Wisconsin Health (US), University of Minnesota Medical Center (US), Children's Hospital of Illinois (US), Northwestern Medicine (US), Texas Children's Hospital (US), Wisconsin Division of Public Health (US), Boston Children's Museum (US), Saint Louis University (US), Indiana University – Purdue University Indianapolis (US), Albany Medical Center Hospital (US), Icahn School of Medicine at Mount Sinai (US)
Openalex Percentile: Top 11%
Cardiac and Coronary Surgery Techniques
2.01
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.