Risk factors for hemolysis with centrifugal pumps in pediatric extracorporeal membrane oxygenation: Is pump replacement an answer?

Introduction Hemolysis during pediatric extracorporeal membrane oxygenation (ECMO) is associated with increased risk for renal failure and mortality. Objectives We aim to describe risk factors for hemolysis in pediatric ECMO supported by centrifugal pumps. Methods We conducted an analysis of retrosp...

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Bibliographic Details
Published in:Perfusion 2023-05, Vol.38 (4), p.771-780
Main Authors: Chu, Jian H, Sarathy, Srivats, Ramesh, Sonali, Rudolph, Kristina, Raghavan, Madhavan L, Badheka, Aditya
Format: Article
Language:English
Subjects:
Blood transfusion
Centrifugal pumps
Child
Erythrocytes
Exchanging
Extracorporeal membrane oxygenation
Extracorporeal Membrane Oxygenation - adverse effects
Hemoglobin
Hemoglobins
Hemolysis
Humans
Membranes
Oxygenation
Patients
Pediatrics
Pumps
Regression analysis
Regression models
Renal failure
Retrospective Studies
Risk Factors
Risk reduction
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Summary:Introduction Hemolysis during pediatric extracorporeal membrane oxygenation (ECMO) is associated with increased risk for renal failure and mortality. Objectives We aim to describe risk factors for hemolysis in pediatric ECMO supported by centrifugal pumps. Methods We conducted an analysis of retrospective data collected at an academic children’s hospital from January 2017 to December 2019. Measurements and results Plasma-free hemoglobin (PFH) levels were measured daily, and hemolysis was defined as PFH>50 mg/dL. Of 46 ECMO runs over 528 ECMO days, hemolysis occurred in 23 (58%) patients over a total of 40 (8%) ECMO days. In multivariable logistic regression models, VA-ECMO (aOR=4.69, 95% CI: 1.01–21.83) and higher hemoglobin (aOR = 1.38, 95% CI: 1.06–1.81) were independently associated with hemolysis. There were also non-significant trends toward increased risk for hemolysis with higher rotational pump speed (aOR=2.39, 95% CI: 0.75–7.65), higher packed red blood cell transfusions (aOR=1.15, 95% CI: 0.99–1.34), and higher cryoprecipitate transfusions (aOR=2.01, 95% CI: 0.83–4.86). Isolated pump exchanges that were performed in 12 patients with hemolysis led to significant decreases in PFH levels within 24 h (89 vs 11 mg/dL, p
ISSN:0267-6591
1477-111X
DOI:10.1177/02676591221082499