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

Autor:	Shibao K; From the Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan., Shibata T; From the Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.; Division of Cardiac Care Unit, Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Japan., Kitamura C; From the Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan., Matushima Y; From the Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.; Division of Cardiac Care Unit, Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Japan., Yoshiga T; From the Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan., Yanai T; From the Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.; Division of Cardiac Care Unit, Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Japan., Homma T; From the Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.; Division of Cardiac Care Unit, Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Japan., Otsuka M; From the Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.; Division of Cardiac Care Unit, Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Japan., Murotani K; Department of Biostatistics Center, Kurume University School of Medicine, Kurume, Japan., Fukumoto Y; From the Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.
Jazyk:	angličtina
Zdroj:	ASAIO journal (American Society for Artificial Internal Organs : 1992) [ASAIO J] 2024 Dec 01; Vol. 70 (12), pp. 1017-1024. Date of Electronic Publication: 2024 May 15.
DOI:	10.1097/MAT.0000000000002229
Abstrakt:	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. Competing Interests: Disclosure: The authors have no conflicts of interest to report. (Copyright © ASAIO 2024.)
Databáze:	MEDLINE
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