{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T23:15:15Z","timestamp":1783552515443,"version":"3.55.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K08HL169915"],"award-info":[{"award-number":["K08HL169915"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"American Heart Association-Harold Amos Medical Faculty Development Program"},{"DOI":"10.13039\/100020836","name":"Intervalien Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020836","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Multiple veno-arterial extracorporeal membrane oxygenation (VA-ECMO) studies have recently reported that early hyperoxia is associated with increased mortality; yet, the underlying mechanism is unclear. As prior analyses did not account for native cardiac output or fraction of delivered oxygen, it remains unknown whether hyperoxia is directly injurious or primarily a surrogate of poor intrinsic cardiac function and proximal mixing. This study aims to evaluate whether hyperoxia is an independent predictor of mortality in VA-ECMO patients or whether it primarily reflects impaired native cardiac function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We conducted a single-centre retrospective cohort study of 227 VA-ECMO patients to evaluate the relationship between hyperoxia and intensive care unit (ICU) mortality, accounting for native cardiac index using multivariable regression and principal component analysis. Average PaO2 and cardiac index were analysed as continuous variables. Decreased cardiac index was the strongest independent predictor of ICU mortality in a multivariable regression [odds ratio (OR) 0.22; 95% confidence interval (CI): 0.06\u20130.70; P = 0.018]. After adjusting for native cardiac index and utilization of advanced therapies (i.e. heart transplant or left ventricular assist device), the association between hyperoxia and mortality became insignificant. Average PaO2 and cardiac index were strongly inversely collinear [variance inflation factor (VIF) = 7.2 and 11.5, respectively], with their interaction term yielding a VIF of 20.3. Non-survivors and survivors who received advanced therapies share similar PC1 score distributions (a weighted composite of average PaO2 and cardiac index) and impaired haemodynamic profiles, including reduced ejection fraction, pulse pressures, and oxygen delivery indices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The association between early hyperoxia and mortality in VA-ECMO is primarily driven by underlying cardiac failure rather than direct oxygen toxicity. The availability of advanced therapies further modifies this relationship, underscoring the need to account for both native cardiac output and heart replacement strategies when evaluating optimal PaO2 targets and the independent effect of hyperoxia on VA-ECMO outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjacc\/zuag082","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:21:09Z","timestamp":1781612469000},"source":"Crossref","is-referenced-by-count":0,"title":["Hyperoxia reflects poor native cardiac function and demonstrates cardiac index-dependent associations with mortality in veno-arterial extracorporeal membrane oxygenation patients"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0375-2553","authenticated-orcid":false,"given":"Ryan K","family":"Ruaysungnoen","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of California San Francisco , 505 Parnassus Ave., San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2873-0662","authenticated-orcid":false,"given":"Anja","family":"Strehlow","sequence":"additional","affiliation":[{"name":"Advanced Heart Failure Comprehensive Care Center, University of California San Francisco , 513 Parnassus Ave, MSB 1134, San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8275-1040","authenticated-orcid":false,"given":"Sylvie","family":"Baudart","sequence":"additional","affiliation":[{"name":"Advanced Heart Failure Comprehensive Care Center, University of California San Francisco , 513 Parnassus Ave, MSB 1134, San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3816-7979","authenticated-orcid":false,"given":"Yu","family":"Wu","sequence":"additional","affiliation":[{"name":"Advanced Heart Failure Comprehensive Care Center, University of California San Francisco , 513 Parnassus Ave, MSB 1134, San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1479-760X","authenticated-orcid":false,"given":"Amy G","family":"Fiedler","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University of California San Francisco , San Francisco, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1095-5794","authenticated-orcid":false,"given":"Christopher F","family":"Barnett","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of California San Francisco , 505 Parnassus Ave., San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason W","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University of California San Francisco , San Francisco, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6324-5086","authenticated-orcid":false,"given":"Pablo A","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of California San Francisco , 505 Parnassus Ave., San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0547-1480","authenticated-orcid":false,"given":"Liviu","family":"Klein","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of California San Francisco , 505 Parnassus Ave., San Francisco, CA 94143 ,","place":["USA"]},{"name":"Advanced Heart Failure Comprehensive Care Center, University of California San Francisco , 513 Parnassus Ave, MSB 1134, San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3762-7918","authenticated-orcid":false,"given":"Samuel B","family":"Brusca","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of California San Francisco , 505 Parnassus Ave., San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan H","family":"Baik","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of California San Francisco , 505 Parnassus Ave., San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2325-8317","authenticated-orcid":false,"given":"Connor G","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of California San Francisco , 505 Parnassus Ave., San Francisco, CA 94143 ,","place":["USA"]},{"name":"Advanced Heart Failure Comprehensive Care Center, University of California San Francisco , 513 Parnassus Ave, MSB 1134, San Francisco, CA 94143 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"2026070818313021000_zuag082-B1","doi-asserted-by":"crossref","first-page":"2776","DOI":"10.1053\/j.jvca.2019.12.047","article-title":"Clinical management of venoarterial extracorporeal membrane oxygenation","volume":"34","author":"Hoyler","year":"2020","journal-title":"J Cardiothorac Vasc 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