TY - JOUR
T1 - Characterizing the Racial Discrepancy in Hypoxemia Detection in Venovenous Extracorporeal Membrane Oxygenation
T2 - An Extracorporeal Life Support Organization Registry Analysis
AU - Kalra, Andrew
AU - Wilcox, Christopher
AU - Holmes, Sari D
AU - Tonna, Joseph E
AU - Jeong, In Seok
AU - Rycus, Peter
AU - Anders, Marc M
AU - Zaaqoq, Akram M
AU - Lorusso, Roberto
AU - Brodie, Daniel
AU - Keller, Steven P
AU - Kim, Bo Soo
AU - Whitman, Glenn J R
AU - Cho, Sung-Min
PY - 2024/8
Y1 - 2024/8
N2 - Purpose: Skin pigmentation influences peripheral oxygen saturation (SpO
2) compared to arterial saturation of oxygen (SaO
2). Occult hypoxemia (SaO
2 ≤ 88% with SpO
2 ≥ 92%) is associated with increased in-hospital mortality in venovenous-extracorporeal membrane oxygenation (VV-ECMO) patients. We hypothesized VV-ECMO cannulation, in addition to race/ethnicity, accentuates the SpO
2-SaO
2 discrepancy due to significant hemolysis. Methods: Adults (≥ 18 years) supported with VV-ECMO with concurrently measured SpO
2 and SaO
2 measurements from over 500 centers in the Extracorporeal Life Support Organization Registry (1/2018–5/2023) were included. Multivariable logistic regressions were performed to examine whether race/ethnicity was associated with occult hypoxemia in pre-ECMO and on-ECMO SpO
2-SaO
2 calculations. Results: Of 13,171 VV-ECMO patients, there were 7772 (59%) White, 2114 (16%) Hispanic, 1777 (14%) Black, and 1508 (11%) Asian patients. The frequency of on-ECMO occult hypoxemia was 2.0% (N = 233). Occult hypoxemia was more common in Black and Hispanic patients versus White patients (3.1% versus 1.7%, P < 0.001 and 2.5% versus 1.7%, P = 0.025, respectively). In multivariable logistic regression, Black patients were at higher risk of pre-ECMO occult hypoxemia versus White patients (adjusted odds ratio [aOR] = 1.55, 95% confidence interval [CI] = 1.18–2.02, P = 0.001). For on-ECMO occult hypoxemia, Black patients (aOR = 1.79, 95% CI = 1.16–2.75, P = 0.008) and Hispanic patients (aOR = 1.71, 95% CI = 1.15–2.55, P = 0.008) had higher risk versus White patients. Higher pump flow rates (aOR = 1.29, 95% CI = 1.08–1.55, P = 0.005) and on-ECMO 24-h lactate (aOR = 1.06, 95% CI = 1.03–1.10, P < 0.001) significantly increased the risk of on-ECMO occult hypoxemia. Conclusion: SaO
2 should be carefully monitored if using SpO
2 during ECMO support for Black and Hispanic patients especially for those with high pump flow and lactate values at risk for occult hypoxemia.
AB - Purpose: Skin pigmentation influences peripheral oxygen saturation (SpO
2) compared to arterial saturation of oxygen (SaO
2). Occult hypoxemia (SaO
2 ≤ 88% with SpO
2 ≥ 92%) is associated with increased in-hospital mortality in venovenous-extracorporeal membrane oxygenation (VV-ECMO) patients. We hypothesized VV-ECMO cannulation, in addition to race/ethnicity, accentuates the SpO
2-SaO
2 discrepancy due to significant hemolysis. Methods: Adults (≥ 18 years) supported with VV-ECMO with concurrently measured SpO
2 and SaO
2 measurements from over 500 centers in the Extracorporeal Life Support Organization Registry (1/2018–5/2023) were included. Multivariable logistic regressions were performed to examine whether race/ethnicity was associated with occult hypoxemia in pre-ECMO and on-ECMO SpO
2-SaO
2 calculations. Results: Of 13,171 VV-ECMO patients, there were 7772 (59%) White, 2114 (16%) Hispanic, 1777 (14%) Black, and 1508 (11%) Asian patients. The frequency of on-ECMO occult hypoxemia was 2.0% (N = 233). Occult hypoxemia was more common in Black and Hispanic patients versus White patients (3.1% versus 1.7%, P < 0.001 and 2.5% versus 1.7%, P = 0.025, respectively). In multivariable logistic regression, Black patients were at higher risk of pre-ECMO occult hypoxemia versus White patients (adjusted odds ratio [aOR] = 1.55, 95% confidence interval [CI] = 1.18–2.02, P = 0.001). For on-ECMO occult hypoxemia, Black patients (aOR = 1.79, 95% CI = 1.16–2.75, P = 0.008) and Hispanic patients (aOR = 1.71, 95% CI = 1.15–2.55, P = 0.008) had higher risk versus White patients. Higher pump flow rates (aOR = 1.29, 95% CI = 1.08–1.55, P = 0.005) and on-ECMO 24-h lactate (aOR = 1.06, 95% CI = 1.03–1.10, P < 0.001) significantly increased the risk of on-ECMO occult hypoxemia. Conclusion: SaO
2 should be carefully monitored if using SpO
2 during ECMO support for Black and Hispanic patients especially for those with high pump flow and lactate values at risk for occult hypoxemia.
KW - Arterial blood gas
KW - Hypoxemia
KW - Pulse oximetry
KW - Racial/ethnical disparities
KW - Venovenous extracorporeal membrane oxygenation
U2 - 10.1007/s00408-024-00711-4
DO - 10.1007/s00408-024-00711-4
M3 - Article
SN - 1432-1750
VL - 202
SP - 471
EP - 481
JO - Lung
JF - Lung
IS - 4
ER -