Inadequate oxygen delivery index dose is associated with cardiac arrest risk in neonates following cardiopulmonary bypass surgery

RESUSCITATION

卷:142

Article

Futterman, Craig¹  Salvin, Joshua W.²  McManus, Michael³  Lowry, Adam W.⁴  Baronov, Dimitar³  Almodovar, Melvin C.⁵  Pineda, Jose A.⁶  Nadkarni, Vinay M.⁷  Laussen, Peter C.⁸  Gazit, Avihu Z.^9,10 

[1] George Washington Univ, Childrens Natl Med Ctr, Div Cardiac Crit Care Med, 111 Michigan Ave NW, Washington, DC 20001 USA

[2] Harvard Med Sch, Boston Childrens Hosp, Dept Cardiol, Div Cardiovasc Crit Cares Med, 300 Longwood Ave, Boston, MA 02115 USA

[3] Etiometry Inc, 280 Summer St Fl 4, Boston, MA 02210 USA

[4] Univ Cent Florida, Nemours Childrens Hosp, Nemours Cardiac Ctr, Dept Cardiovasc Serv,Div Cardiac Crit Care, 13535 Nemours Pkwy, Orlando, FL 32827 USA

[5] Univ Miami, Miller Sch Med, Holtz Childrens Hosp Jackson Hlth Syst, Dept Pediat,Div Cardiol & Crit Care Med, 1611 NW 12th Ave,North Wing,Suite 109, Miami, FL 33136 USA

[6] Washington Univ, St Louis Childrens Hosp, Sch Med, Dept Pediat & Neurol, 1 Childrens Pl, St Louis, MO 63110 USA

[7] Univ Penn, Childrens Hosp Philadelphia, Perelman Sch Med, Dept Anesthesiol Crit Care & Pediat, 3401 Civ Ctr Blvd, Philadelphia, PA 19104 USA

[8] Hosp Sick Children, Dept Crit Care Med, 555 Univ Ave, Toronto, ON M5G 1X8, Canada

[9] Washington Univ, St Louis Childrens Hosp, Sch Med, Dept Pediat,Div Crit Care Med, 1 Childrens Pl, St Louis, MO 63110 USA

[10] Washington Univ, St Louis Childrens Hosp, Sch Med, Dept Pediat,Div Cardiol, 1 Childrens Pl, St Louis, MO 63110 USA

关键词: Cardiac arrest;    Pediatric cardiac critical care;    CICU;    Critical congenital heart disease;    IDO2 index;    IDO2 dose;    Prediction;   

DOI  :  10.1016/j.resuscitation.2019.07.013

来源: Elsevier

【 摘 要 】

Aim: To evaluate the Inadequate oxygen delivery (IDO2) index dose as a predictor of cardiac arrest (CA) in neonates following congenital heart surgery. Methods: Retrospective cohort study in 3 US pediatric cardiac intensive units (1/2011- 8/2016). Calculated IDO2 index values were blinded to bedside clinicians and generated from data collected up to 30 days postoperatively, or until death or ECMO initiation. Control event data was collected from patients who did not experience CA or require ECMO. IDO2 dose was computed over a 120-min window up to 30 min prior to the CA and control events. A multivariate logistic regression prediction model including the IDO2 dose and presence or absence of a single ventricle (SV) was used. Model performance metrics were the odds ratio for each regression coefficient and receiver operating characteristic area under the curve (ROC AUC). Results: Of 897 patients monitored during the study period, 601 met inclusion criteria: 29 patients had CA (33 events) and 572 patients were used for control events. Seventeen (59%) CA and 125 (26%) control events occurred in SV patients. Median age/weight at surgery and level of monitoring were similar in both groups. Median postoperative event time was 0.73 days [0.05-22.39] in CA patients and 0.82 days [0.08 25.11] in control patients. Odds ratio of the IDO2 dose coefficient was 1.008 (95% CI: 1.006-1.012, p =0.0445), and 2.952 (95% CI: 2.952-3.258, p =0.0079) in SV. The HOC AUC using both coefficients was 0.74 (95% CI: 0.73-0.75). These associations of IDO2 dose with CA risk remained robust, even when censored periods prior to arrest were 10 and 20 min. Conclusion: In neonates post-CPB surgery, higher IDO2 index dose over a 120-min monitoring period is associated with increased risk of cardiac arrest, even when censoring data 10, 20 or 30 min prior to the CA event.

【 授权许可】

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