| Issue |
J Extra Corpor Technol
Volume 58, Number 1, March 2026
|
|
|---|---|---|
| Page(s) | 32 - 38 | |
| DOI | https://doi.org/10.1051/ject/2025057 | |
| Published online | 13 March 2026 | |
Original Article
Impact of early hyperoxia on outcomes during neonatal and pediatric veno-arterial extracorporeal life support★
1
Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
2
Emory University School of Medicine, Atlanta, GA, USA
3
Physician Assistant, Children’s Healthcare of Atlanta, Atlanta, GA, USA
4
Research Coordinator, Children’s Healthcare of Atlanta, Atlanta, GA, USA
5
Advance Technology Coordinator, ECMO and Advanced Technologies, Children’s Healthcare of Atlanta, Atlanta, GA, USA
6
Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
* Corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.
; This email address is being protected from spambots. You need JavaScript enabled to view it.
Received:
9
July
2025
Accepted:
12
October
2025
Abstract
Background: Hyperoxia induces oxidative stress and can exacerbate inflammatory response to Veno-Arterial Extracorporeal Life Support (VA–ECLS). This study aimed to evaluate the association between hyperoxia during VA–ECLS and morbidity, complications, and in-hospital mortality. Methods: This study included pediatric patients who received VA–ECLS between 2014 and 2019. Hyperoxia severity was categorized as mild (PaO2: 101–200 mmHg), moderate (PaO2: 201–300 mmHg), and severe (PaO2 > 300 mmHg. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included a composite measure of cardiovascular or renal complications, AKI, and change in Functional Status. Results: Among 229 patients supported on VA–ECLS runs, 73.4% involved neonates. Median age and weight of the entire cohort were 2.5 months (IQR 0.3, 19.0), and 4.4 kg (IQR 3.2, 10.7), respectively. Cardiac indications accounted for 48.9% of cases. Hyperoxia occurred in 79% of patients and was more common in those requiring ECLS for cardiac indications. The overall in-hospital mortality rate was 45%, increasing to 64% in the severe hyperoxia cohort (p = 0.23). Severe hyperoxia was significantly associated with the composite outcome of cardiovascular or renal complications but not in-hospital mortality in multivariable analysis. No association was found between hyperoxia, AKI, and adverse functional outcomes. Conclusions: Standardized PaO2 targets to minimize hyperoxia may improve outcomes for patients supported on VA–ECLS.
Key words: Hyperoxia / ECLS / Mortality / ECLS Complications / Functional Status Scale
Presented at the Annual Pediatric Cardiac Intensive Care Society meeting in November 2024.
© The Author(s), published by EDP Sciences, 2026
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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