Magnitude of arterial carbon dioxide change at initiation of extracorporeal membrane oxygenation support is associated with survival

Melania Bembea, Ramon Lee, Desiree Masten, Kathleen K. Kibler, Christoph U. Lehmann, Kenneth M. Brady, R. Blaine Easley

Research output: Contribution to journalArticle

Abstract

Many patient factors have been associated with mortality from extracorporeal membrane oxygenation (ECMO) therapy. Pre-ECMO patient pH and arterial carbon dioxide (paCO2) have been associated with poor outcome and can be significantly altered by ECMO initiation. We hypothesized that the magnitude of change in paCO2 and pH with ECMO initiation could be associated with survival. We designed a retrospective observational study from a single tertiary care center and included all pediatric patients (age younger than 18 years) undergoing ECMO between 2002 and 2010. Electronic records were queried for demographics and clinical characteristics, including the arterial blood gas (ABG) pre- and post-ECMO initiation. Bivariate analysis compared ECMO course characteristics by outcome (survivor vs. nonsurvivor). Multivariable logistic regression was performed on factors associated with the outcome in the bivariate analysis at the significance level of p pH, paCO2, indication, and intracranial hemorrhage were significantly associated with mortality (p paCO2 change (≥25 mmHg) was associated with mortality (adjusted OR, 2.21; 95% CI, 1.06-4.63; p =.036). The decrease in paCO2 with ECMO initiation was associated with mortality. Although this change in paCO2 is multifactorial, it represents a modifiable element of clinical management involving pre-ECMO ventilation, ECMO circuit priming, CO2 administration/removal, and may represent a future therapeutic target that could improve survival in pediatric ECMO.

Original languageEnglish (US)
Pages (from-to)26-32
Number of pages7
JournalJournal of Extra-Corporeal Technology
Volume45
Issue number1
StatePublished - 2013

Fingerprint

Extracorporeal Membrane Oxygenation
Carbon Dioxide
Survival
Mortality
Pediatrics
Intracranial Hemorrhages
Tertiary Care Centers
Observational Studies
Survivors
Retrospective Studies
Gases
Logistic Models
Demography

Keywords

  • ECLS
  • ECMO
  • Extracorporeal life support
  • Extracorporeal membrane oxygenation
  • Outcome
  • Pediatric

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Cardiology and Cardiovascular Medicine
  • Health Professions (miscellaneous)

Cite this

Magnitude of arterial carbon dioxide change at initiation of extracorporeal membrane oxygenation support is associated with survival. / Bembea, Melania; Lee, Ramon; Masten, Desiree; Kibler, Kathleen K.; Lehmann, Christoph U.; Brady, Kenneth M.; Easley, R. Blaine.

In: Journal of Extra-Corporeal Technology, Vol. 45, No. 1, 2013, p. 26-32.

Research output: Contribution to journalArticle

Bembea, Melania ; Lee, Ramon ; Masten, Desiree ; Kibler, Kathleen K. ; Lehmann, Christoph U. ; Brady, Kenneth M. ; Easley, R. Blaine. / Magnitude of arterial carbon dioxide change at initiation of extracorporeal membrane oxygenation support is associated with survival. In: Journal of Extra-Corporeal Technology. 2013 ; Vol. 45, No. 1. pp. 26-32.
@article{105c8cb196a4404786763e88879f536a,
title = "Magnitude of arterial carbon dioxide change at initiation of extracorporeal membrane oxygenation support is associated with survival",
abstract = "Many patient factors have been associated with mortality from extracorporeal membrane oxygenation (ECMO) therapy. Pre-ECMO patient pH and arterial carbon dioxide (paCO2) have been associated with poor outcome and can be significantly altered by ECMO initiation. We hypothesized that the magnitude of change in paCO2 and pH with ECMO initiation could be associated with survival. We designed a retrospective observational study from a single tertiary care center and included all pediatric patients (age younger than 18 years) undergoing ECMO between 2002 and 2010. Electronic records were queried for demographics and clinical characteristics, including the arterial blood gas (ABG) pre- and post-ECMO initiation. Bivariate analysis compared ECMO course characteristics by outcome (survivor vs. nonsurvivor). Multivariable logistic regression was performed on factors associated with the outcome in the bivariate analysis at the significance level of p pH, paCO2, indication, and intracranial hemorrhage were significantly associated with mortality (p paCO2 change (≥25 mmHg) was associated with mortality (adjusted OR, 2.21; 95{\%} CI, 1.06-4.63; p =.036). The decrease in paCO2 with ECMO initiation was associated with mortality. Although this change in paCO2 is multifactorial, it represents a modifiable element of clinical management involving pre-ECMO ventilation, ECMO circuit priming, CO2 administration/removal, and may represent a future therapeutic target that could improve survival in pediatric ECMO.",
keywords = "ECLS, ECMO, Extracorporeal life support, Extracorporeal membrane oxygenation, Outcome, Pediatric",
author = "Melania Bembea and Ramon Lee and Desiree Masten and Kibler, {Kathleen K.} and Lehmann, {Christoph U.} and Brady, {Kenneth M.} and Easley, {R. Blaine}",
year = "2013",
language = "English (US)",
volume = "45",
pages = "26--32",
journal = "Journal of Extra-Corporeal Technology",
issn = "0022-1058",
publisher = "American Society of Extra-Corporeal Technology",
number = "1",

}

TY - JOUR

T1 - Magnitude of arterial carbon dioxide change at initiation of extracorporeal membrane oxygenation support is associated with survival

AU - Bembea, Melania

AU - Lee, Ramon

AU - Masten, Desiree

AU - Kibler, Kathleen K.

AU - Lehmann, Christoph U.

AU - Brady, Kenneth M.

AU - Easley, R. Blaine

PY - 2013

Y1 - 2013

N2 - Many patient factors have been associated with mortality from extracorporeal membrane oxygenation (ECMO) therapy. Pre-ECMO patient pH and arterial carbon dioxide (paCO2) have been associated with poor outcome and can be significantly altered by ECMO initiation. We hypothesized that the magnitude of change in paCO2 and pH with ECMO initiation could be associated with survival. We designed a retrospective observational study from a single tertiary care center and included all pediatric patients (age younger than 18 years) undergoing ECMO between 2002 and 2010. Electronic records were queried for demographics and clinical characteristics, including the arterial blood gas (ABG) pre- and post-ECMO initiation. Bivariate analysis compared ECMO course characteristics by outcome (survivor vs. nonsurvivor). Multivariable logistic regression was performed on factors associated with the outcome in the bivariate analysis at the significance level of p pH, paCO2, indication, and intracranial hemorrhage were significantly associated with mortality (p paCO2 change (≥25 mmHg) was associated with mortality (adjusted OR, 2.21; 95% CI, 1.06-4.63; p =.036). The decrease in paCO2 with ECMO initiation was associated with mortality. Although this change in paCO2 is multifactorial, it represents a modifiable element of clinical management involving pre-ECMO ventilation, ECMO circuit priming, CO2 administration/removal, and may represent a future therapeutic target that could improve survival in pediatric ECMO.

AB - Many patient factors have been associated with mortality from extracorporeal membrane oxygenation (ECMO) therapy. Pre-ECMO patient pH and arterial carbon dioxide (paCO2) have been associated with poor outcome and can be significantly altered by ECMO initiation. We hypothesized that the magnitude of change in paCO2 and pH with ECMO initiation could be associated with survival. We designed a retrospective observational study from a single tertiary care center and included all pediatric patients (age younger than 18 years) undergoing ECMO between 2002 and 2010. Electronic records were queried for demographics and clinical characteristics, including the arterial blood gas (ABG) pre- and post-ECMO initiation. Bivariate analysis compared ECMO course characteristics by outcome (survivor vs. nonsurvivor). Multivariable logistic regression was performed on factors associated with the outcome in the bivariate analysis at the significance level of p pH, paCO2, indication, and intracranial hemorrhage were significantly associated with mortality (p paCO2 change (≥25 mmHg) was associated with mortality (adjusted OR, 2.21; 95% CI, 1.06-4.63; p =.036). The decrease in paCO2 with ECMO initiation was associated with mortality. Although this change in paCO2 is multifactorial, it represents a modifiable element of clinical management involving pre-ECMO ventilation, ECMO circuit priming, CO2 administration/removal, and may represent a future therapeutic target that could improve survival in pediatric ECMO.

KW - ECLS

KW - ECMO

KW - Extracorporeal life support

KW - Extracorporeal membrane oxygenation

KW - Outcome

KW - Pediatric

UR - http://www.scopus.com/inward/record.url?scp=84879285549&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879285549&partnerID=8YFLogxK

M3 - Article

C2 - 23691781

AN - SCOPUS:84879285549

VL - 45

SP - 26

EP - 32

JO - Journal of Extra-Corporeal Technology

JF - Journal of Extra-Corporeal Technology

SN - 0022-1058

IS - 1

ER -