An Analysis of Risk Factors for Hemolysis in Children on Extracorporeal Membrane Oxygenation

Objectives: Hemolysis is a known complication of pediatric extracorporeal membrane oxygenation associated with renal failure and mortality. We sought to identify predictors of hemolysis in pediatric extracorporeal membrane oxygenation patients and determine its influence on outcomes. Design: Retrospective, single-center study. Setting: Urban, quaternary care center pediatric and neonatal ICU. Patients: Ninety-six patients requiring extracorporeal membrane oxygenation. Interventions: None. Measurements and Main Results: Daily measurements of plasma-free hemoglobin were obtained while patients were on extracorporeal membrane oxygenation. Patients with a prior extracorporeal membrane oxygenation run, on extracorporeal membrane oxygenation for less than 24 hours, or without complete medical records were excluded from the study. Ninety-six patients met inclusion criteria, of which, 25 patients (26%) had plasma-free hemoglobin greater than 30 mg/dL. Of those patients, 15 of 25(60%) had plasma-free hemoglobin greater than 50 mg/dL, and 21 of 25(84%) occurred during the first 7 days on extracorporeal membrane oxygenation. Compared with patients without hemolysis, those with hemolysis were younger (0.2 mo [0.06–3.2 mo] vs 8.2 mo [0.6–86 mo]; p 30 mg/dL) had a 10-fold increase in in-hospital mortality. In our study cohort, hemolysis was associated with continuous ultrafiltration use, but not continuous renal replacement therapy. Additionally, our results suggest that the degree of coagulopathy (international normalized ratio > 3.5) at the time of cannulation influences hemolysis. Additional prospective studies are necessary to define further strategies to prevent hemolysis and improve outcomes in pediatric extracorporeal membrane oxygenation patients. This work was performed at Columbia University Herbert and Florence Irving Medical Center, Morgan-Stanley Children’s Hospital of New York-Presbyterian. The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: so2462@cumc.columbia.edu ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2OwKLx8