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 language | English (US) |
|---|---|
| Pages (from-to) | 1067-1076 |
| Number of pages | 10 |
| Journal | Pediatric Critical Care Medicine |
| Volume | 19 |
| Issue number | 11 |
| DOIs | |
| State | Published - Jan 1 2018 |
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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
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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 journal › Article
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
UR - http://www.scopus.com/inward/record.url?scp=85056259195&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85056259195&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000001709
DO - 10.1097/PCC.0000000000001709
M3 - Article
C2 - 30106767
AN - SCOPUS:85056259195
VL - 19
SP - 1067
EP - 1076
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 11
ER -