ECPELLA is the simultaneous use of an Impella (Abiomed, USA), a percutaneous transvalvular microaxial flow pump, and venoarterial extracorporeal membrane oxygenation for mechanical circulatory support.1,2
A 53-yr-old male with ischemic cardiomyopathy was bridged to heart transplantation using ECPELLA support. His venoarterial extracorporeal membrane oxygenation circuit consisted of a right femoral vein drainage cannula and a left femoral artery return cannula. He had an Impella 5.5 in place through his right axillary artery. A computed tomography angiogram showed the mixing cloud present when the antegrade flow from the heart and the Impella 5.5 meets the retrograde flow from the peripheral venoarterial extracorporeal membrane oxygenation return cannula. The distal aorta lacked contrast in both early and late arterial phase images, making this finding unlikely to be an artifact of inappropriately early imaging after contrast injection.
Differential hypoxemia (Harlequin or North-south syndrome) is a phenomenon seen in patients on ECPELLA...