(201) Correlating Inadequate Oxygen Delivery Index With Outcomes in Pediatric Patients Receiving VA ECMO

Introduction: Weaning from VA ECMO is one of the most challenging aspects of ECMO management, requiring the expertise of a large team and incorporation of multiple data points in real time. The inadequate oxygen delivery index (IDO2), a risk analytics algorithm, is used to estimate the risk of a patient experiencing inadequate systemic oxygen delivery. The utility of IDO2 supplementing clinical decision-making in decannulation and correlation with post decannulation outcomes is unknown. We hypothesize that the IDO2 index will correlate with weaning success in pediatric patients receiving VA-ECMO.

Methods: This is a single-center, retrospective cohort study. Demographics, clinical data and IDO2 were collected for children < 12 years of age that were cannulated for VA ECMO. Terminal decannulation cases and cases without IDO2 data were excluded. IDO2 values were recorded at 5-sec intervals for each patient during their clamp trial(s) and in the 24 hours following decannulation. Mean IDO2 was calculated for each clamp trial and during the +15-minute period surrounding follow-up time points of 1, 6, 12, and 24 hours following decannulation.

Results: Of 40 ECMO cases, 9 patients met inclusion criteria. 4 patients experienced failed clamp trials of the 9. Two patients demonstrated higher average IDO2 in their first failed clamp trial when compared to their successful clamp trials. One patient had a total of 4 failed clamp trials over 5 days, with a consistently low IDO2 for the final 3 trials. The distribution of IDO2 across time did not significantly differ (p=.084) when comparing IDO2 during their successful clamp trial to follow-up time points. Patients with higher values at the 24-hour time point correlated with a longer LOS (Spearman’s, 0.712). Patients with CHD appeared to demonstrate a higher mean IDO2 during clamp trials and more IDO2 variability compared to other diagnoses.

Conclusions: This the first study to analyze the IDO2 index in pediatric patients during the weaning process from VA ECMO. Although limited by our small sample size, future research directions were identified. Future data collection across multiple sites may identify IDO2 thresholds which could inform clinicians during the decannulation assessment. Elevated IDO2 at 24 hours following decannulation may correlate with a longer LOS.