The association between early arterial oxygen and carbon dioxide with neurologic outcomes after pediatric ECPR in children with cardiac disease.

Abstract

Explore relationships between early post-extracorporeal cardiopulmonary resuscitation (ECPR) oxygenation, ventilation, and survival to hospital discharge (SHD) with favorable neurologic outcome in children with cardiac disease. Retrospective cohort study of patients undergoing ECPR at a single center pediatric cardiac intensive care unit. Primary exposure variables were change in PaO₂ (partial pressure of arterial oxygen), defined as mean PaO₂ post-ECPR minus pre-ECPR PaO₂, and PaCO₂ (partial pressure of arterial carbon dioxide) category (hypocarbia: <35 mmHg, normocarbia: 35-45 mmHg, hypercarbia: >45 mmHg) during the first 6 h after ROC. Primary outcome was SHD with favorable neurological outcome defined by Pediatric Cerebral Performance Category score of 1, 2, 3 or no change from baseline. Secondary outcomes included overall SHD and neuroimaging injury. Univariable and multivariable logistic regression analyses were performed. We analyzed 78 index ECPR events from 2010 to 2022. The median [IQR] change in PaO₂ was +127.5 [93, 184.7]. After controlling for potential confounders, patients with smaller changes in PaO₂ had higher odds of SHD with favorable neurological outcome and overall SHD. Although there was no association with PaCO₂ category and SHD with favorable neurological outcome, patients with hypocarbia vs. normocarbia had higher odds of overall SHD. Neuroimaging injury was associated with hypercarbia compared to hypocarbia. In children with cardiac disease, early arterial oxygen changes may have a stronger association with SHD with favorable neurological outcome than carbon dioxide fluctuations. Further multicenter analyses are warranted to further explore these observations.