{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:27:43Z","timestamp":1787772463731,"version":"build-2784847793"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>ABSTRACT<\/jats:title>\n                    <jats:p>The use of ECPELLA in patients with severe lung disease may result in an unfavorable phenomenon of differential hypoxia. The simultaneous evaluation of three arterial blood samples from different arterial line (right radial artery, left radial artery, ECMO arterial line) in patients at risk of Harlequin syndrome (also called differential hypoxemia (DH)) can localize the \u201cmixing cloud\u201d along the aorta. Focusing the attention on the \u201cmixing cloud\u201d position instead of on isolated flows of Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) and Impella CP makes the decision making easier about how to modify MCSs flows according to the clinical context. Herein, we present two cases in which ECPELLA configuration was used to treat a cardiogenic shock condition and how the ECPELLA-induced hypoxia was managed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aca.aca_176_21","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T05:52:05Z","timestamp":1716875525000},"page":"97-101","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":13,"title":["Management of Harlequin Syndrome Under ECPELLA Support"],"prefix":"10.4103","volume":"26","author":[{"given":"Matteo","family":"Giunta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa G.","family":"Recchia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Capuano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Toscano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Attisani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Rinaldi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Brazzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-18-20240901","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/joic.12080","article-title":"The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic 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percutaneous left ventricular decompression therapy with Impella is associated with improved outcomes in refractory cardiogenic shock","volume":"65","author":"Patel","year":"2019","journal-title":"ASAIO J"},{"key":"R5-18-20240901","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/0267659119830513","article-title":"Differential hypoxemia during venoarterial extracorporeal membrane oxygenation","volume":"34","author":"Falk","year":"2019","journal-title":"Perfusion"},{"key":"R6-18-20240901","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/MAT.0000000000000804","article-title":"EC-VAD: Combined use of extracorporeal membrane oxygenation and percutaneous microaxial pump left ventricular assist device","volume":"65","author":"Akanni","year":"2019","journal-title":"ASAIO J"},{"key":"R7-18-20240901","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.athoracsur.2016.12.049","article-title":"Left ventricular unloading by Impella device versus surgical vent during extracorporeal life support","volume":"104","author":"Tepper","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"R8-18-20240901","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1177\/0267659120956540","article-title":"A therapeutic concept to resolve a possible coronary desaturation under Ecpella support and maximize the potential for myocardial recovery: Combination of veno-arteriovenous extracorporeal membrane oxygenation and Impella (VAVEcpella)","volume":"36","author":"Ushijima","year":"2021","journal-title":"Perfusion"},{"key":"R9-18-20240901","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jccase.2020.05.004","article-title":"Successful weaning from veno-arterial ECMO and Impella2.5 by veno-venous and arterial ECMO (v-ECPELLA) for a patient with acute myocardial infarction complicated by severe lung injury","volume":"22","author":"Shimizu","year":"2020","journal-title":"J Cardiol Cases"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_176_21","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:48:19Z","timestamp":1787770099000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_176_21"}},"subtitle":["A Report of Two Cases and a Proposed Approach"],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_176_21","relation":{},"ISSN":["0971-9784"],"issn-type":[{"value":"0971-9784","type":"print"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}