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



      To evaluate the Inadequate oxygen delivery (IDO2) index dose as a predictor of cardiac arrest (CA) in neonates following congenital heart surgery.


      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).


      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 ROC 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.


      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.


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        • Lowry A.W.
        • Knudson J.D.
        • Cabrera A.G.
        • et al.
        Cardiopulmonary resuscitation in hospitalized children with cardiovascular disease: estimated prevalence and outcomes from the kids’ inpatient database.
        Pediatr Crit Care Med. 2013; 14: 248-255
        • Berg R.A.
        • Nadkarni V.M.
        • Clark A.E.
        • et al.
        Incidence and outcomes of cardiopulmonary resuscitation in pediatric intensive care units.
        Crit Care Med. 2016; 44: 798-808
        • Alten J.A.
        • Klugman D.
        • Raymond T.T.
        • et al.
        Epidemiology and outcomes of cardiac arrest in pediatric cardiac ICUs.
        Pediatr Crit Care Med. 2017; 18: 935-943
        • Baronov B.
        • McManus M.
        • Butler E.
        • Douglas C.
        • MC Almodovar
        Next generation patient monitor powered by In-Silico physiology.
        Conf Proc IEEE Eng Med Biol Soc. 2015; 2015: 4447-4453
        • Graham E.M.
        • Forbus G.A.
        • Bradley S.M.
        • Shirali G.S.
        • Atz A.M.
        • Charleston S.C.
        Incidence and outcome of cardiopulmonary resuscitation in patients with shunted single ventricle: Advantage of right ventricle to pulmonary artery shunt.
        J Thorac Cardiovasc Surg. 2006; 131: e7-e8
        • Bewick V.
        • Cheek K.
        • Ball J.
        Statistics review 14: logistic regression.
        Crit Care. 2005; 9: 112-118
        • Parra D.A.
        • Totapally B.R.
        • Zahn E.
        • et al.
        Outcome of cardiopulmonary resuscitation in a pediatric cardiac intensive care unit.
        Crit Care Med. 2000; 28: 3296-3300
        • Rhodes J.F.
        • Blaufox A.D.
        • Seiden H.S.
        • et al.
        Cardiac arrest in infants after congenital heart surgery.
        Circulation. 1999; 100: II194-II199
        • Ortmann L.
        • Prodhan P.
        • Gossett J.
        • et al.
        American Heart Association’s get with the guidelines–resuscitation investigators: outcomes after in-hospital cardiac arrest in children with cardiac disease: a report from get with the guidelines–resuscitation.
        Circulation. 2011; 124: 2329-2337
        • Gupta P.
        • Jacobs J.P.
        • Pasquali S.K.
        • et al.
        Epidemiology and outcomes after in-hospital cardiac arrest after pediatric cardiac surgery.
        Ann Thorac Surg. 2014; 98 (discussion 2144): 2138-2143
        • Bonafide C.P.
        • Lin R.
        • Zander M.
        • et al.
        Association between exposure to nonactionable physiologic monitor alarms and response time in a children’s hospital.
        J Hosp Med. 2015; 10: 345-351
        • McShea M.
        • Holl R.
        • Badawi O.
        • et al.
        The eICU research institute-a collaboration between industry, health care providers, and academia.
        IEEE Eng Med Biol Mag. 2010; 29: 18-25
        • Lee J.
        • Scott D.J.
        • Villaroel M.
        • et al.
        Open access MIMIC-II database for intensive care research.
        Conf Proc IEEE Eng Med Biol Mag. 2011; 2011: 8315-8318
        • Kennedy C.E.
        • Aoki N.
        • Mariscalco M.
        • Turley J.P.
        Using time series analysis to predict cardiac arrest in a PICU.
        Pediatr Crit Care Med. 2015; 16: 332-339
        • Egdell P.
        • Finlay L.
        • Pedley D.K.
        The PAWS score: validation of an early warning scoring system for the initial assessment of children in the emergency department.
        Emerg Med J. 2008; 25: 745-749
        • Hodgetts T.J.
        • Kenward G.
        • Vlachonikolis I.G.
        • et al.
        The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team.
        Resuscitation. 2002; 54: 125-131
        • Subbe C.P.
        • Kruger M.
        • Rutherford P.
        • et al.
        Validation of a modified early warning score in medical admissions.
        QJM. 2001; 94: 521-526
        • Pollack M.M.
        • Patel K.M.
        • Ruttimann U.E.
        PRISM III: an updated pediatric risk of mortality score.
        Crit Care Med. 1996; 24: 743-752
        • Pollack M.M.
        • Ruttimann U.E.
        • Getson P.R.
        Pediatric risk of mortality (PRISM) score.
        Crit Care Med. 1988; 16: 1110-1116
        • Leteurtre S.
        • Martinot A.
        • Duhamel A.
        • et al.
        Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational multicentre study.
        Lancet. 2003; 362: 192-197
        • Eitan D.
        • Goodwin A.
        • Laussen P.
        • Guerguerian A.M.
        Insights from multi-dimensional physiological signals to predict and prevent cardiac arrests.
        Pediatr Crit Care Med. 2016; 17: 81-82