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. 2025 Feb 1;71(2):99-108.
doi: 10.1097/MAT.0000000000002294. Epub 2024 Aug 23.

Pulse Pressure and Acute Brain Injury in Venoarterial Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Analysis

Andrew Kalra  1   2 , Jin Kook Kang  1 , Christopher Wilcox  3 , Benjamin L Shou  1 , Patricia Brown  1 , Peter Rycus  4 , Marc M Anders  5 , Akram M Zaaqoq  6 , Daniel Brodie  7 , Glenn J R Whitman  1 , Sung-Min Cho  1   8 ; HERALD group
Collaborators, Affiliations

Pulse Pressure and Acute Brain Injury in Venoarterial Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Analysis

Andrew Kalra et al. ASAIO J. .

Abstract

Low pulse pressure (PP) in venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is a marker of cardiac dysfunction and has been associated with acute brain injury (ABI) as continuous-flow centrifugal pump may lead to endothelial dysregulation. We retrospectively analyzed adults (≥18 years) receiving "peripheral" VA-ECMO for cardiogenic shock in the Extracorporeal Life Support Organization Registry (January 2018-July 2023). Acute brain injury (our primary outcome) included central nervous system (CNS) ischemia, intracranial hemorrhage, brain death, and seizures. Multivariable logistic regressions were performed to examine whether PP ≤10 mm Hg was associated with ABI. Of 9,807 peripheral VA-ECMO patients (median age = 57.4 years, 67% = male), 8,294 (85%) had PP >10 mm Hg versus 1,513 (15%) had PP ≤10 mm Hg. Patients with PP ≤10 mm Hg experienced ABI more frequently versus PP >10 mm Hg (15% versus 11%, p < 0.001). After adjustment, PP ≤10 mm Hg was independently associated with ABI (adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI] = 1.06-1.48, p = 0.01). Central nervous system ischemia and brain death were more common in patients with PP ≤10 versus PP >10 mm Hg (8% versus 6%, p = 0.008; 3% versus 1%, p < 0.001). Pulse pressure ≤10 mm Hg was associated with CNS ischemia (aOR = 1.26, 95% CI = 1.02-1.56, p = 0.03) but not intracranial hemorrhage (aOR = 1.14, 95% CI = 0.85-1.54, p = 0.38). Early low PP (≤10 mm Hg) at 24 hours of ECMO support was associated with ABI, particularly CNS ischemia, in peripheral VA-ECMO patients.

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Conflict of interest statement

Disclosure: D.B. receives research support from and consults for LivaNova. He has been on the medical advisory boards for Abiomed, Xenios, Medtronic, Inspira and Cellenkos. He is the President-elect of the Extracorporeal Life Support Organization (ELSO) and the Chair of the Executive Committee of the International ECMO Network (ECMONet), and he writes for UpToDate. S.-M.C. is supported by NHLBI (1K23HL157610) and Hyperfine (SAFE MRI ECMO study). The other authors have no conflicts of interest to report.

Figures

Figure 1.
Figure 1.
Flow diagram for the creation of our study cohort from the ELSO Registry (1/2018–7/2023). VA-ECMO: venoarterial extracorporeal membrane oxygenation. CS: cardiogenic shock. cVAD: central venous access device. DBP: diastolic blood pressure. ELSO: Extracorporeal Life Support Organization. pVAD: percutaneous ventricular assist device. SBP: systolic blood pressure.
Figure 2.
Figure 2.
Boxplot of pulse pressure (y-axis) vs. peripheral venoarterial extracorporeal membrane oxygenation patients with acute brain injury and those without acute brain injury (x-axis). ABI: acute brain injury.
Figure 3.
Figure 3.
Forest plot of multivariable logistic regression model for occurrence of acute brain injury in peripheral venoarterial extracorporeal membrane oxygenation patients. ECMO: extracorporeal membrane oxygenation. PaCO2: partial pressure of carbon dioxide. PaO2: partial pressure of oxygen.
Figure 4.
Figure 4.
Forest plot of multivariable logistic regression model for occurrence of A) central nervous system ischemia and B) intracranial hemorrhage in peripheral venoarterial extracorporeal membrane oxygenation patients. ECMO: extracorporeal membrane oxygenation. PaCO2: partial pressure of carbon dioxide. PaO2: partial pressure of oxygen.
See this image and copyright information in PMC

References

    1. Jentzer JC, Miller PE, Alviar C, Yalamuri S, Bohman JK, Tonna JE: Exposure to Arterial Hyperoxia During Extracorporeal Membrane Oxygenator Support and Mortality in Patients With Cardiogenic Shock. Circ Heart Fail 16 (4): e010328, 2023. doi: 10.1161/circheartfailure.122.010328. - DOI - PMC - PubMed
    1. Cho SM, Canner J, Chiarini G, et al.: Modifiable Risk Factors and Mortality From Ischemic and Hemorrhagic Strokes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Organization Registry. Crit Care Med 48 (10): e897–e905, 2020. doi: 10.1097/ccm.0000000000004498. - DOI - PMC - PubMed
    1. Homan TD, Bordes SJ, Cichowski E: Physiology, Pulse Pressure. StatPearls. Treasure Island (FL), StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC., 2023. - PubMed
    1. Lee SI, Lim YS, Park CH, Choi WS, Choi CH: Importance of pulse pressure after extracorporeal cardiopulmonary resuscitation. J Card Surg 36 (8): 2743–2750, 2021. doi: 10.1111/jocs.15614. - DOI - PubMed
    1. Purohit SN, Cornwell WK 3rd, Pal JD, Lindenfeld J, Ambardekar AV: Living Without a Pulse: The Vascular Implications of Continuous-Flow Left Ventricular Assist Devices. Circ Heart Fail 11 (6): e004670, 2018. doi: 10.1161/circheartfailure.117.004670. - DOI - PMC - PubMed