Inhaled Nitric Oxide Therapy and Changes in Pulmonary Artery Pulsatility Index During Venoarterial Extracorporeal Membrane Oxygenation Weaning in Cardiogenic Shock Requiring ECPELLA.

BACKGROUND: Inhaled nitric oxide (iNO) selectively dilates pulmonary vessels and reduces pulmonary vascular resistance, potentially improving right ventricular (RV) function. However, its clinical benefit in patients with cardiogenic shock requiring ECPELLA (i.e., combined Impella® (ABIOMED) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains unclear. The aim of this study was to evaluate the impact of iNO on RV function in this critical population. METHODS AND RESULTS: Between September 2017 and June 2023, we retrospectively analyzed 54 consecutive patients with cardiogenic shock treated with ECPELLA. Patients were divided into 2 groups based on the use of iNO. RV function was assessed using the pulmonary artery pulsatility index (PAPi) at the time of ECPELLA initiation (Pre-PAPi) and VA-ECMO weaning (Post-PAPi). The iNO group had a significantly lower Pre-PAPi, prompting propensity-score matching to adjust for baseline differences. After matching, the Post-PAPi was significantly higher in the iNO group than in the non-iNO group (1.95 [1.63-3.00] vs. 1.40 [0.50-2.05], P<0.05). A significant interaction between iNO use and PAPi change was observed (P=0.006), suggesting an iNO-mediated improvement in RV function. CONCLUSIONS: In patients with cardiogenic shock requiring ECPELLA support, adjunctive iNO therapy was associated with greater improvement in PAPi at the time of VA-ECMO weaning. These findings suggest a potential role for iNO in optimizing hemodynamics during the transition from ECPELLA to Impella-only support.