Hemolysis during pediatric extracorporeal membrane oxygenation: Associations with circuitry, complications, and mortality

Heidi J. Dalton, Katherine Cashen, Ron W. Reeder, Robert A. Berg, Thomas Patrick Shanley, Christopher J.L. Newth, Murray M. Pollack, David Wessel, Joseph Carcillo, Rick Harrison, J. Michael Dean, Kathleen L. Meert*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: To describe factors associated with hemolysis during pediatric extracorporeal membrane oxygenation and the relationships between hemolysis, complications, and mortality. Design: Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Setting: Three Collaborative Pediatric Critical Care Research Network-affiliated hospitals. Patients: Age less than 19 years and treated with extracorporeal membrane oxygenation. Interventions: None. Measurements and Main Results: Hemolysis was defined based on peak plasma free hemoglobin levels during extracorporeal membrane oxygenation and categorized as none (< 0.001g/L), mild (0.001 to < 0.5g/L), moderate (0.5 to < 1.0g/L), or severe (≥ 1.0g/L). Of 216 patients, four (1.9%) had no hemolysis, 67 (31.0%) had mild, 51 (23.6%) had moderate, and 94 (43.5%) had severe. On multivariable analysis, variables independently associated with higher daily plasma free hemoglobin concentration included the use of in-line hemofiltration or other continuous renal replacement therapy, higher hemoglobin concentration, higher total bilirubin concentration, lower mean heparin infusion dose, lower body weight, and lower platelet count. Using multivariable Cox modeling, daily plasma free hemoglobin was independently associated with development of renal failure during extracorporeal membrane oxygenation (defined as creatinine > 2mg/dL [> 176.8 μmol/L] or use of in-line hemofiltration or continuous renal replacement therapy) (hazard ratio, 1.04; 95% CI, 1.02–1.06; p < 0.001), but not mortality (hazard ratio, 1.01; 95% CI, 0.99–1.04; p = 0.389). Conclusions: Hemolysis is common during pediatric extracorporeal membrane oxygenation. Hemolysis may contribute to the development of renal failure, and therapies used to manage renal failure such as in-line hemofiltration and other forms of continuous renal replacement therapy may contribute to hemolysis. Hemolysis was not associated with mortality after controlling for other factors. Monitoring for hemolysis should be a routine part of extracorporeal membrane oxygenation practice, and efforts to reduce hemolysis may improve patient care.

Original languageEnglish (US)
Pages (from-to)1067-1076
Number of pages10
JournalPediatric Critical Care Medicine
Volume19
Issue number11
DOIs
StatePublished - Jan 1 2018

Fingerprint

Extracorporeal Membrane Oxygenation
Hemolysis
Pediatrics
Mortality
Hemofiltration
Renal Replacement Therapy
Critical Care
Renal Insufficiency
Research
Patient Care
Hemoglobins

Keywords

  • Child
  • Extracorporeal membrane oxygenation
  • Hemolysis
  • Neonate
  • Plasma free hemoglobin

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Dalton, Heidi J. ; Cashen, Katherine ; Reeder, Ron W. ; Berg, Robert A. ; Shanley, Thomas Patrick ; Newth, Christopher J.L. ; Pollack, Murray M. ; Wessel, David ; Carcillo, Joseph ; Harrison, Rick ; Dean, J. Michael ; Meert, Kathleen L. / Hemolysis during pediatric extracorporeal membrane oxygenation : Associations with circuitry, complications, and mortality. In: Pediatric Critical Care Medicine. 2018 ; Vol. 19, No. 11. pp. 1067-1076.
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title = "Hemolysis during pediatric extracorporeal membrane oxygenation: Associations with circuitry, complications, and mortality",
abstract = "Objectives: To describe factors associated with hemolysis during pediatric extracorporeal membrane oxygenation and the relationships between hemolysis, complications, and mortality. Design: Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Setting: Three Collaborative Pediatric Critical Care Research Network-affiliated hospitals. Patients: Age less than 19 years and treated with extracorporeal membrane oxygenation. Interventions: None. Measurements and Main Results: Hemolysis was defined based on peak plasma free hemoglobin levels during extracorporeal membrane oxygenation and categorized as none (< 0.001g/L), mild (0.001 to < 0.5g/L), moderate (0.5 to < 1.0g/L), or severe (≥ 1.0g/L). Of 216 patients, four (1.9{\%}) had no hemolysis, 67 (31.0{\%}) had mild, 51 (23.6{\%}) had moderate, and 94 (43.5{\%}) had severe. On multivariable analysis, variables independently associated with higher daily plasma free hemoglobin concentration included the use of in-line hemofiltration or other continuous renal replacement therapy, higher hemoglobin concentration, higher total bilirubin concentration, lower mean heparin infusion dose, lower body weight, and lower platelet count. Using multivariable Cox modeling, daily plasma free hemoglobin was independently associated with development of renal failure during extracorporeal membrane oxygenation (defined as creatinine > 2mg/dL [> 176.8 μmol/L] or use of in-line hemofiltration or continuous renal replacement therapy) (hazard ratio, 1.04; 95{\%} CI, 1.02–1.06; p < 0.001), but not mortality (hazard ratio, 1.01; 95{\%} CI, 0.99–1.04; p = 0.389). Conclusions: Hemolysis is common during pediatric extracorporeal membrane oxygenation. Hemolysis may contribute to the development of renal failure, and therapies used to manage renal failure such as in-line hemofiltration and other forms of continuous renal replacement therapy may contribute to hemolysis. Hemolysis was not associated with mortality after controlling for other factors. Monitoring for hemolysis should be a routine part of extracorporeal membrane oxygenation practice, and efforts to reduce hemolysis may improve patient care.",
keywords = "Child, Extracorporeal membrane oxygenation, Hemolysis, Neonate, Plasma free hemoglobin",
author = "Dalton, {Heidi J.} and Katherine Cashen and Reeder, {Ron W.} and Berg, {Robert A.} and Shanley, {Thomas Patrick} and Newth, {Christopher J.L.} and Pollack, {Murray M.} and David Wessel and Joseph Carcillo and Rick Harrison and Dean, {J. Michael} and Meert, {Kathleen L.}",
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Dalton, HJ, Cashen, K, Reeder, RW, Berg, RA, Shanley, TP, Newth, CJL, Pollack, MM, Wessel, D, Carcillo, J, Harrison, R, Dean, JM & Meert, KL 2018, 'Hemolysis during pediatric extracorporeal membrane oxygenation: Associations with circuitry, complications, and mortality', Pediatric Critical Care Medicine, vol. 19, no. 11, pp. 1067-1076. https://doi.org/10.1097/PCC.0000000000001709

Hemolysis during pediatric extracorporeal membrane oxygenation : Associations with circuitry, complications, and mortality. / Dalton, Heidi J.; Cashen, Katherine; Reeder, Ron W.; Berg, Robert A.; Shanley, Thomas Patrick; Newth, Christopher J.L.; Pollack, Murray M.; Wessel, David; Carcillo, Joseph; Harrison, Rick; Dean, J. Michael; Meert, Kathleen L.

In: Pediatric Critical Care Medicine, Vol. 19, No. 11, 01.01.2018, p. 1067-1076.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hemolysis during pediatric extracorporeal membrane oxygenation

T2 - Associations with circuitry, complications, and mortality

AU - Dalton, Heidi J.

AU - Cashen, Katherine

AU - Reeder, Ron W.

AU - Berg, Robert A.

AU - Shanley, Thomas Patrick

AU - Newth, Christopher J.L.

AU - Pollack, Murray M.

AU - Wessel, David

AU - Carcillo, Joseph

AU - Harrison, Rick

AU - Dean, J. Michael

AU - Meert, Kathleen L.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: To describe factors associated with hemolysis during pediatric extracorporeal membrane oxygenation and the relationships between hemolysis, complications, and mortality. Design: Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Setting: Three Collaborative Pediatric Critical Care Research Network-affiliated hospitals. Patients: Age less than 19 years and treated with extracorporeal membrane oxygenation. Interventions: None. Measurements and Main Results: Hemolysis was defined based on peak plasma free hemoglobin levels during extracorporeal membrane oxygenation and categorized as none (< 0.001g/L), mild (0.001 to < 0.5g/L), moderate (0.5 to < 1.0g/L), or severe (≥ 1.0g/L). Of 216 patients, four (1.9%) had no hemolysis, 67 (31.0%) had mild, 51 (23.6%) had moderate, and 94 (43.5%) had severe. On multivariable analysis, variables independently associated with higher daily plasma free hemoglobin concentration included the use of in-line hemofiltration or other continuous renal replacement therapy, higher hemoglobin concentration, higher total bilirubin concentration, lower mean heparin infusion dose, lower body weight, and lower platelet count. Using multivariable Cox modeling, daily plasma free hemoglobin was independently associated with development of renal failure during extracorporeal membrane oxygenation (defined as creatinine > 2mg/dL [> 176.8 μmol/L] or use of in-line hemofiltration or continuous renal replacement therapy) (hazard ratio, 1.04; 95% CI, 1.02–1.06; p < 0.001), but not mortality (hazard ratio, 1.01; 95% CI, 0.99–1.04; p = 0.389). Conclusions: Hemolysis is common during pediatric extracorporeal membrane oxygenation. Hemolysis may contribute to the development of renal failure, and therapies used to manage renal failure such as in-line hemofiltration and other forms of continuous renal replacement therapy may contribute to hemolysis. Hemolysis was not associated with mortality after controlling for other factors. Monitoring for hemolysis should be a routine part of extracorporeal membrane oxygenation practice, and efforts to reduce hemolysis may improve patient care.

AB - Objectives: To describe factors associated with hemolysis during pediatric extracorporeal membrane oxygenation and the relationships between hemolysis, complications, and mortality. Design: Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Setting: Three Collaborative Pediatric Critical Care Research Network-affiliated hospitals. Patients: Age less than 19 years and treated with extracorporeal membrane oxygenation. Interventions: None. Measurements and Main Results: Hemolysis was defined based on peak plasma free hemoglobin levels during extracorporeal membrane oxygenation and categorized as none (< 0.001g/L), mild (0.001 to < 0.5g/L), moderate (0.5 to < 1.0g/L), or severe (≥ 1.0g/L). Of 216 patients, four (1.9%) had no hemolysis, 67 (31.0%) had mild, 51 (23.6%) had moderate, and 94 (43.5%) had severe. On multivariable analysis, variables independently associated with higher daily plasma free hemoglobin concentration included the use of in-line hemofiltration or other continuous renal replacement therapy, higher hemoglobin concentration, higher total bilirubin concentration, lower mean heparin infusion dose, lower body weight, and lower platelet count. Using multivariable Cox modeling, daily plasma free hemoglobin was independently associated with development of renal failure during extracorporeal membrane oxygenation (defined as creatinine > 2mg/dL [> 176.8 μmol/L] or use of in-line hemofiltration or continuous renal replacement therapy) (hazard ratio, 1.04; 95% CI, 1.02–1.06; p < 0.001), but not mortality (hazard ratio, 1.01; 95% CI, 0.99–1.04; p = 0.389). Conclusions: Hemolysis is common during pediatric extracorporeal membrane oxygenation. Hemolysis may contribute to the development of renal failure, and therapies used to manage renal failure such as in-line hemofiltration and other forms of continuous renal replacement therapy may contribute to hemolysis. Hemolysis was not associated with mortality after controlling for other factors. Monitoring for hemolysis should be a routine part of extracorporeal membrane oxygenation practice, and efforts to reduce hemolysis may improve patient care.

KW - Child

KW - Extracorporeal membrane oxygenation

KW - Hemolysis

KW - Neonate

KW - Plasma free hemoglobin

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DO - 10.1097/PCC.0000000000001709

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