Language

English

Publication Date

11-8-2025

Journal

Journal of the American Heart Association

DOI

10.1161/JAHA.125.045890

PMID

41205226

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 (MACE), which included CPR, extracorporeal support, stroke, and mortality. Logistic regression assessed the associations between median PaO2 during CPB and outcomes in the entire cohort and subset of patients with single ventricle (SV) anatomy.

Results: We analyzed 1,175 neonates, including 357 with SV anatomy. Median PaO2 during CPB was 296 mmHg (range: 54 - 800), with significant variation across centers (p< 0.001). There were 54 deaths (5%) and 203 MACE (17%). No patients with PaO2< 200mmHg (n=161) died, and PaO2> 221 demonstrated modest mortality prediction (96% sensitivity, 19% specificity). In multivariable analysis, before adjustment for center, PaO2> 221 mmHg was significantly associated with mortality and MACE in all patients and patients with SV anatomy. After adjustment for center, associations between hyperoxia and mortality (p=0.053) or MACE (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.

Keywords

Cardiopulmonary Bypass, Heart Defects, Congenital, Hospital mortality, Hyperoxia, Infant, Newborn, Oxygen

Published Open-Access

yes

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