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Introduction <p>CO<sub>2</sub>-derived variables, veno-arterial CO<sub>2</sub> content gradient (ΔCCO<sub>2</sub>) and the ratio of ΔCCO<sub>2</sub> with arterio-venous oxygen difference (AV-DO<sub>2</sub>) (ΔCCO2/AV-DO<sub>2</sub>), may have a potential role as indicators of low cardiac output and anaerobic metabolism, respectively. We sought to describe and evaluate the association of CO<sub>2</sub>-derived variables with patients’ outcomes in the post cardiopulmonary bypass (CPB) period in children.</p> Methods <p>Prospective, single-center, study enrolling children post-CPB with paired arterial and venous blood gases for determination of lactate, O<sub>2</sub> extraction, ΔCCO<sub>2</sub>, and ΔCCO<sub>2</sub>/AV-DO<sub>2</sub> at admission (H0), and at 6 (H6), 12 (H12) and 24 (H24) hours. Different clinical patterns were defined based on the presence of an anaerobic context or a hypoperfusion context, using both O<sub>2</sub> and CO<sub>2</sub>-derived variables. The presence of anaerobic metabolism was defined with a lactate &gt; 2&#xa0;mmol/l and ΔCCO<sub>2</sub>/AV-DO<sub>2</sub> &gt; 1.8; the presence of hypoperfusion was defined with an O<sub>2</sub> extraction &gt; 30% and ΔCCO<sub>2</sub> &gt; 6&#xa0;mL. The potential association of duration of amine support and mechanical ventilation was tested with CO<sub>2</sub>-derived variables and specific clinical patterns.</p> Results <p>A total of 51 patients with a median age of 36 (IQR 11–85) months were included. Median admission ΔCCO<sub>2</sub> was 9.3&#xa0;mL (IQR 5.6–11.4) with 72% above 6&#xa0;mL. Median ΔCCO<sub>2</sub>/AV-DO<sub>2</sub> was 2.1 (IQR 1.5–2.4) with 58% above 1.8. Admission ΔCCO<sub>2</sub> showed a significant association with the duration of mechanical ventilation (R2 21.6, <i>p</i> value = 0.001) but not with the duration of vasoactive support. Neither H0 ΔCCO<sub>2</sub> nor H0 ΔCCO<sub>2</sub>/AV-DO<sub>2</sub> improved outcome prediction by a model including lactate and O<sub>2</sub> extraction. Anaerobic metabolism context showed a significant association with prolonged vasoactive support [28.4 (CI 95% 12.2–44.6) <i>p</i> = 0.001] and mechanical ventilation duration [1.4 (95% CI 0.62–2.3) <i>p</i> = 0.003]. In hypoperfusion context, neither duration of vasoactive support nor mechanical ventilation appeared different in the subgroups analysis.</p> Conclusion <p>CO<sub>2</sub>-derived variables may improve outcome prediction after cardiac surgery in pediatric patients. Further evaluation in larger multicentered trials is necessary to improve its validation.</p>

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Veno-arterial CO2 content gradient and veno-arterial CO2 to arterial-venous O2 content ratio for outcome prediction after pediatric cardiac surgery: a prospective study

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  • 发表日期：

    2025年12月10日

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  • Vladimir L. Cousin,
  • Raphael Joye,
  • Tomasz Nalecz,
  • Tornike Sologashvili,
  • Maurice Beghetti,
  • Cyril Jaksic,
  • Julie Wacker,
  • Angelo Polito

摘要

Introduction

CO2-derived variables, veno-arterial CO2 content gradient (ΔCCO2) and the ratio of ΔCCO2 with arterio-venous oxygen difference (AV-DO2) (ΔCCO2/AV-DO2), may have a potential role as indicators of low cardiac output and anaerobic metabolism, respectively. We sought to describe and evaluate the association of CO2-derived variables with patients’ outcomes in the post cardiopulmonary bypass (CPB) period in children.

Methods

Prospective, single-center, study enrolling children post-CPB with paired arterial and venous blood gases for determination of lactate, O2 extraction, ΔCCO2, and ΔCCO2/AV-DO2 at admission (H0), and at 6 (H6), 12 (H12) and 24 (H24) hours. Different clinical patterns were defined based on the presence of an anaerobic context or a hypoperfusion context, using both O2 and CO2-derived variables. The presence of anaerobic metabolism was defined with a lactate > 2 mmol/l and ΔCCO2/AV-DO2 > 1.8; the presence of hypoperfusion was defined with an O2 extraction > 30% and ΔCCO2 > 6 mL. The potential association of duration of amine support and mechanical ventilation was tested with CO2-derived variables and specific clinical patterns.

Results

A total of 51 patients with a median age of 36 (IQR 11–85) months were included. Median admission ΔCCO2 was 9.3 mL (IQR 5.6–11.4) with 72% above 6 mL. Median ΔCCO2/AV-DO2 was 2.1 (IQR 1.5–2.4) with 58% above 1.8. Admission ΔCCO2 showed a significant association with the duration of mechanical ventilation (R2 21.6, p value = 0.001) but not with the duration of vasoactive support. Neither H0 ΔCCO2 nor H0 ΔCCO2/AV-DO2 improved outcome prediction by a model including lactate and O2 extraction. Anaerobic metabolism context showed a significant association with prolonged vasoactive support [28.4 (CI 95% 12.2–44.6) p = 0.001] and mechanical ventilation duration [1.4 (95% CI 0.62–2.3) p = 0.003]. In hypoperfusion context, neither duration of vasoactive support nor mechanical ventilation appeared different in the subgroups analysis.

Conclusion

CO2-derived variables may improve outcome prediction after cardiac surgery in pediatric patients. Further evaluation in larger multicentered trials is necessary to improve its validation.