Journal article
Risk factors for hemolysis with centrifugal pumps in pediatric extracorporeal membrane oxygenation: Is pump replacement an answer?
Perfusion, Vol.38(4), pp.771-780
05/2023
DOI: 10.1177/02676591221082499
PMID: 35354417
Abstract
Hemolysis during pediatric extracorporeal membrane oxygenation (ECMO) is associated with increased risk for renal failure and mortality.
We aim to describe risk factors for hemolysis in pediatric ECMO supported by centrifugal pumps.
We conducted an analysis of retrospective data collected at an academic children's hospital from January 2017 to December 2019.
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,
<0.01).
Hemolysis is common in pediatric ECMO using centrifugal pumps. Avoidance of high pump speeds and conservative administration of blood products may help to mitigate the risk for hemolysis. Furthermore, pump exchange may be an effective first-line treatment for hemolysis.
Details
- Title: Subtitle
- Risk factors for hemolysis with centrifugal pumps in pediatric extracorporeal membrane oxygenation: Is pump replacement an answer?
- Creators
- Jian H Chu - Department of Internal Medicine, 20512Rush University Medical Center, Chicago, IL, USASrivats Sarathy - 4083University of Iowa Seamans Center for the Engineering Arts and Sciences, Iowa City, IA 52242, USASonali Ramesh - Division of Pediatric Critical Care, Department of Pediatrics, 21827University of Iowa Stead Family Children's Hospital, Iowa City, IA 52242, USAKristina Rudolph - Heart and Vascular Center, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USAMadhavan L Raghavan - 4083University of Iowa Seamans Center for the Engineering Arts and Sciences, Iowa City, IA 52242, USAAditya Badheka - Division of Pediatric Critical Care, Department of Pediatrics, 21827University of Iowa Stead Family Children's Hospital, Iowa City, IA 52242, USA
- Resource Type
- Journal article
- Publication Details
- Perfusion, Vol.38(4), pp.771-780
- DOI
- 10.1177/02676591221082499
- PMID
- 35354417
- ISSN
- 0267-6591
- eISSN
- 1477-111X
- Grant note
- name: National Center For Advancing Translational Sciences of the National Institutes of Health, award: UL1TR002537
- Language
- English
- Electronic publication date
- 03/30/2022
- Date published
- 05/2023
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Critical Care; Stead Family Department of Pediatrics
- Record Identifier
- 9984230623902771
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