Differential Hypoxia Risk in Cardiopulmonary Arrest Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation and IMPELLA Support

Kodai Shibao; Tatsuhiro Shibata; Chisato Kitamura; Yoshihisa Matushima; Takumi Yoshiga; Toshiyuki Yanai; Takehiro Homma; Maki Otsuka; Kenta Murotani; Yoshihiro Fukumoto

doi:10.1097/MAT.0000000000002229

Differential Hypoxia Risk in Cardiopulmonary Arrest Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation and IMPELLA Support

ASAIO J. 2024 May 17. doi: 10.1097/MAT.0000000000002229. Online ahead of print.

Authors

Kodai Shibao¹, Tatsuhiro Shibata^{1

2}, Chisato Kitamura¹, Yoshihisa Matushima^{1

2}, Takumi Yoshiga¹, Toshiyuki Yanai^{1

2}, Takehiro Homma^{1

2}, Maki Otsuka^{1

2}, Kenta Murotani³, Yoshihiro Fukumoto¹

Affiliations

¹ From the Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.
² Division of Cardiac Care Unit, Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Japan.
³ Department of Biostatistics Center, Kurume University School of Medicine, Kurume, Japan.

PMID: 38753573
DOI: 10.1097/MAT.0000000000002229

Abstract

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a therapeutic strategy for managing cardiogenic shock. However, it carries the risk of cardiogenic pulmonary edema, potentially leading to differential hypoxia. Although IMPELLA can mitigate pulmonary congestion, the combination of VA-ECMO and IMPELLA has frequently resulted in differential hypoxia, requiring a transition from VA-ECMO to veno-arteriovenous extracorporeal membrane oxygenation (VAV-ECMO). Therefore, this study aimed to examine the influence of IMPELLA on the incidence of differential hypoxia, necessitating a shift to VAV-ECMO. This single-center, retrospective, observational study included patients who experienced cardiopulmonary arrest and received treatment with VA-ECMO combined with an intra-aortic balloon pump (IABP) or IMPELLA between 2017 and 2022. The primary endpoint assessed the incidence of differential hypoxia, necessitating a switch to VAV-ECMO. Patients with cardiopulmonary arrest received treatment with VA-ECMO in combination with IABP (N = 28) or IMPELLA (N = 29). There was a significant increase in differential hypoxia 96 hours post-VA-ECMO initiation in the IMPELLA group, necessitating a transition to VAV-ECMO. The combination of VA-ECMO and IMPELLA in patients experiencing cardiopulmonary arrest may significantly increase the risk of differential hypoxia. A multidisciplinary approach employing mechanical circulatory support is crucial, with ongoing consideration of the potential risks associated with differential hypoxia.