Pulse Oximetry and Arterial Blood Gas Oxygen Saturation Discrepancies and Mortality in Extracorporeal Cardiopulmonary Resuscitation Patients: An Extracorporeal Life Support Organization Registry Analysis

医学 四分位间距 体外膜肺氧合 低氧血症 心肺复苏术 体外心肺复苏 体外 麻醉 氧饱和度 复苏 动脉血 内科学 心脏病学 氧气 化学 有机化学
作者
Andrew Kalra,Christopher Wilcox,Winnie Liu,S. Feng,Patricia M. Brown,Bo Soo Kim,Daniel Brodie,Glenn Whitman,Sung‐Min Cho
出处
期刊:Critical Care Medicine [Lippincott Williams & Wilkins]
标识
DOI:10.1097/ccm.0000000000006736
摘要

Objectives: Previous studies have shown that inaccurate peripheral oxygen saturation (SpO2) readings compared with arterial oxygen saturation (SaO2) may occur in extracorporeal membrane oxygenation (ECMO) patients. We hypothesized that a greater Sp o 2 –Sa o 2 discrepancy in extracorporeal cardiopulmonary resuscitation (ECPR) patients is associated with higher mortality due to unrecognized hypoxemia. Design: Retrospective analysis. Setting: Data within the Extracorporeal Life Support Organization Registry from 496 ECMO centers (2018–2024). Patients: Patients 18 years old or older receiving ECPR (first-run only). Interventions: None. Measurements and Main Results: Laboratory measurements including Sp o 2 –Sa o 2 were measured at 24 hours of ECMO support. Acute brain injury (ABI) included hypoxic-ischemic brain injury, ischemic stroke, intracranial hemorrhage, and seizures. Based on an inflection point in cubic spline analysis, a Sp o 2 –Sa o 2 threshold greater than or equal to 4% was used as a binary variable to assess its association with in-hospital mortality. Three thousand nine hundred seventy ECPR patients (median age, 57 yr; 71% male) were included. The median ECMO duration was 4 days (interquartile range, 2–7 d). There were 634 patients (16%) with Sp o 2 –Sa o 2 greater than or equal to 4% and 3336 (84%) with Sp o 2 –Sa o 2 less than 4%. Overall mortality was 60% ( n = 2391). Patients with Sp o 2 –Sa o 2 greater than or equal to 4% had higher mortality compared with patients with Sp o 2 –Sa o 2 less than 4% (67%, n = 425 vs. 59%, n = 1966; p < 0.001). Patients with Sp o 2 –Sa o 2 greater than or equal to 4% had higher serum lactate values than those with Sp o 2 –Sa o 2 less than 4% (3.1 vs. 2.8 mmol/L; p = 0.0017). In multivariable logistic regression adjusted for preselected covariates, Sp o 2 –Sa o 2 greater than or equal to 4% was associated with increased risk of mortality (adjusted odds ratio [aOR], 1.39; 95% CI, 1.13–1.71). Additional risk factors associated with higher mortality included ABI (aOR, 5.81; 95% CI, 4.70–7.20), hyperoxemia greater than or equal to 300 mm Hg (aOR, 1.93; 95% CI, 1.53–2.43), hyperoxemia 200–299 mm Hg (aOR, 1.76; 95% CI, 1.37–2.25), gastrointestinal hemorrhage (aOR, 1.69; 95% CI, 1.42–2.00), renal replacement therapy (aOR, 1.48; 95% CI, 1.03–2.11), hypoxemia less than 60 mm Hg (aOR, 1.45; 95% CI, 1.00–2.10), older age (aOR, 1.19; 95% CI, 1.13–1.26), and higher lactate (aOR, 1.17; 95% CI, 1.13–1.20). Race/ethnicity was not associated with higher mortality. Conclusions: Sp o 2 –Sa o 2 greater than or equal to 4% in the first 24 hours after ECPR is associated with increased risk of mortality, potentially due to unrecognized hypoxemia, irrespective of race/ethnicity.
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