Racial and ethnical discrepancy in hypoxemia detection in patients on extracorporeal membrane oxygenationCentral MessagePerspective

Andrew Kalra, BS; Benjamin L. Shou, BS; David Zhao, BA; Christopher Wilcox, DO, MS; Steven P. Keller, MD, PhD, MPhil; Glenn J.R. Whitman, MD; Bo Soo Kim, MD; Sung-Min Cho, DO, MHS; Kate Calligy; Patricia Brown; Diane Alejo; Scott Anderson; Matthew Acton; Hannah Rando; Henry Chang

JTCVS Open (Jun 2023)

Racial and ethnical discrepancy in hypoxemia detection in patients on extracorporeal membrane oxygenationCentral MessagePerspective

Andrew Kalra, BS,
Benjamin L. Shou, BS,
David Zhao, BA,
Christopher Wilcox, DO, MS,
Steven P. Keller, MD, PhD, MPhil,
Glenn J.R. Whitman, MD,
Bo Soo Kim, MD,
Sung-Min Cho, DO, MHS,
Kate Calligy,
Patricia Brown,
Diane Alejo,
Scott Anderson,
Matthew Acton,
Hannah Rando,
Henry Chang

Affiliations

Andrew Kalra, BS: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
Benjamin L. Shou, BS: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
David Zhao, BA: Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md
Christopher Wilcox, DO, MS: Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md
Steven P. Keller, MD, PhD, MPhil: Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md
Glenn J.R. Whitman, MD: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
Bo Soo Kim, MD: Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md
Sung-Min Cho, DO, MHS: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md; Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md; Address for reprints: Sung-Min Cho, DO, MHS, Division of Neurosciences Critical Care, The Johns Hopkins Hospital, 600 N. Wolfe St, Phipps 455, Baltimore, MD 21287.
Kate Calligy: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
Patricia Brown: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
Diane Alejo: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
Scott Anderson: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
Matthew Acton: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
Hannah Rando: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
Henry Chang: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Md; Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md

Journal volume & issue: Vol. 14
pp. 145 – 170

Abstract

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Objective: To determine whether there is racial/ethnical discrepancy between pulse oximetry (SpO2) and oxygen saturation (SaO2) in patients receiving extracorporeal membrane oxygenation (ECMO). Methods: This was a retrospective observational study at a tertiary academic ECMO center with adults (>18 years) on venoarterial (VA) or venovenous (VV) ECMO. Datapoints were excluded if oxygen saturation ≤70% or SpO2–SaO2 pairs were not measured within 10 minutes. The primary outcome was the presence of a SpO2–SaO2 discrepancy between different races/ethnicities. Bland–Altman analyses and linear mixed-effects modeling, adjusting for prespecified covariates, were used to assess the SpO2–SaO2 discrepancy between races/ethnicities. Occult hypoxemia was defined as SaO2 <88% with a time-matched SpO2 ≥92%. Results: Of 139 patients receiving VA-ECMO and 57 patients receiving VV-ECMO, we examined 16,252 SpO2–SaO2 pairs. The SpO2–SaO2 discrepancy was greater in VV-ECMO (1.4%) versus VA-ECMO (0.15%). In VA-ECMO, SpO2 overestimated SaO2 in Asian (0.2%), Black (0.94%), and Hispanic (0.03%) patients and underestimated SaO2 in White (−0.06%) and nonspecified race (−0.80%) patients. The proportion of SpO2–SaO2 measurements considered occult hypoxemia was 70% from Black compared to 27% from White patients (P < .0001). In VV-ECMO, SpO2 overestimated SaO2 in Asian (1.0%), Black (2.9%), Hispanic (1.1%), and White (0.50%) patients and underestimated SaO2 in nonspecified race patients (−0.53%). In linear mixed-effects modeling, SpO2 overestimated SaO2 by 0.19% in Black patients (95% confidence interval, 0.045%-0.33%, P = .023). The proportion of SpO2–SaO2 measurements considered occult hypoxemia was 66% from Black compared with 16% from White patients (P < .0001). Conclusions: SpO2 overestimates SaO2 in Asian, Black, and Hispanic versus White patients, and this discrepancy was greater in VV-ECMO versus VA-ECMO, suggesting the need for physiological studies.

Published in JTCVS Open

ISSN: 2666-2736 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Surgery
Website: https://www.journals.elsevier.com/jtcvs-open

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