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In pediatric patients after cardiac surgery, an anaerobic metabolism context defined by CO2-derived variables and lactate is significantly associated with prolonged vasoactive support and mechanical ventilation, although individual CO2-derived variables do not improve outcome prediction over lactate and O2 extraction alone. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 10, 2025Intensive Care Medicine Experimental1 citationsOpen Access

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

VCVladimir L. CousinUniversité Paris-Saclay RJRaphael JoyeUniversity of Toronto TNTomasz NałęczUniversity Hospital of Geneva

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Abstract

Abstract Introduction CO 2 -derived variables, veno-arterial CO 2 content gradient (ΔCCO 2 ) and the ratio of ΔCCO 2 with arterio-venous oxygen difference (AV-DO 2 ) (ΔCCO2/AV-DO 2 ), 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 2 -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, O 2 extraction, ΔCCO 2 , and ΔCCO 2 /AV-DO 2 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 2 and CO 2 -derived variables. The presence of anaerobic metabolism was defined with a lactate > 2 mmol/l and ΔCCO 2 /AV-DO 2 > 1.8; the presence of hypoperfusion was defined with an O 2 extraction > 30% and ΔCCO 2 > 6 mL. The potential association of duration of amine support and mechanical ventilation was tested with CO 2 -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 ΔCCO 2 was 9.3 mL (IQR 5.6–11.4) with 72% above 6 mL. Median ΔCCO 2 /AV-DO 2 was 2.1 (IQR 1.5–2.4) with 58% above 1.8. Admission ΔCCO 2 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 ΔCCO 2 nor H0 ΔCCO 2 /AV-DO 2 improved outcome prediction by a model including lactate and O 2 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 CO 2 -derived variables may improve outcome prediction after cardiac surgery in pediatric patients. Further evaluation in larger multicentered trials is necessary to improve its validation.

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