Journal of clinical medicine
Association Between End-Tidal Carbon Dioxide and Pulmonary Artery Pulse Pressure During Veno-Arterial Extracorporeal Membrane Oxygenation with Impella®: A Retrospective Exploratory Study
By Shimizu H, Ishino C, Ota T and 12 others.
Abstract
Background
Assessment of native cardiopulmonary circulation is essential during combined veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and Impella® support (ECPELLA). Pulmonary artery catheter (PAC)-derived pulmonary artery pulse pressure (PAPP) is associated with RV stroke volume and pulmonary arterial compliance; however, PAC monitoring has procedure-related risks and technical limitations. End-tidal carbon dioxide (EtCO2) is a simple, continuous, noninvasive indicator of pulmonary blood flow; however, its relationship with PAPP during ECPELLA support remains unclear.
Methods
We retrospectively analyzed adult patients who underwent simultaneous ECPELLA and PAC monitoring between April 2024 and December 2025. Hemodynamic variables and EtCO2 were evaluated on ECPELLA support day 1 and on the final day of V-A ECMO support. Correlations between EtCO2 and PAPP, as well as their temporal changes during ECPELLA support, were assessed using Spearman correlation analysis.