Background:

The mortality rate for a patient with a refractory cardiogenic shock on venoarterial (VA) extracorporealmembrane oxygenation (ECMO) remains high, and hyperoxia might worsen this prognosis. The objective of the pre‑sent study was to evaluate the association between hyperoxia and 28‑day mortality in this setting.

Methods:

We conducted a retrospective bicenter study in two French academic centers. The study population com‑prised adult patients admitted for refractory cardiogenic shock. The following arterial partial pressure of oxygen (PaO 2)variables were recorded for 48 h following admission: the absolute peak PaO2 (the single highest value measuredduring the 48 h), the mean daily peak PaO2 (the mean of each day’s peak values), the overall mean PaO2 (the meanof all values over 48 h), and the severity of hyperoxia (mild: PaO2 < 200 mmHg, moderate: PaO2 = 200–299 mmHg,severe: PaO 2 ≥ 300 mmHg). The main outcome was the 28‑day all‑cause mortality. Inverse probability weighting (IPW)derived from propensity scores was used to reduce imbalances in baseline characteristics.

Results:

From January 2013 to January 2020, 430 patients were included and assessed. The 28‑day mortality rate was43%. The mean daily peak, absolute peak, and overall mean PaO2 values were significantly higher in non‑survivorsthan in survivors. In a multivariate logistic regression analysis, the mean daily peak PaO 2, absolute peak PaO2, andoverall mean PaO2 were independent predictors of 28‑day mortality (adjusted odds ratio [95% confidence intervalper 10 mmHg increment: 2.65 [1.79–6.07], 2.36 [1.67–4.82], and 2.85 [1.12–7.37], respectively). After IPW, high level ofoxygen remained significantly associated with 28‑day mortality (OR = 1.41 [1.01–2.08]; P = 0.041).

Conclusions:

High oxygen levels were associated with 28‑day mortality in patients on VA‑ECMO support for refrac‑tory cardiogenic shock. Our results confirm the need for large randomized controlled trials on this topic.