title: Circuit oxygenator contributes to extracorporeal membrane oxygenation-induced hemolysis.
abstract: Hemolysis can occur as a consequence of extracorporeal membrane oxygenation (ECMO) and is associated with increased mortality and morbidity. Shear stress generated by flow through the circuit and oxygenator is believed to cause ECMO-induced hemolysis. We hypothesize that either a smaller dimension oxygenator or an in-line hemofilter will increase ECMO-associated hemolysis. Circuits were configured with a Quadrox-D Adult oxygenator (surface area 1.8 m), Quadrox-iD Pediatric oxygenator (surface area 0.8 m), or Quadrox-D Adult oxygenator with an in-line hemofilter (N = 4) and ran for 6 hours. Samples were collected hourly from the ECMO circuit and a time-based hemolysis control. Plasma hemoglobin levels were assayed. Circuit-induced hemolysis at each time point was defined as the change in plasma hemoglobin standardized to the time-based hemolysis control. Plasma hemoglobin increased with the use of the smaller dimension pediatric oxygenator as compared with the adult oxygenator when controlling for ECMO run time (p = 0.02). Furthermore, there was a greater pressure gradient with the smaller dimension pediatric oxygenator (p < 0.05). Plasma hemoglobin did not change with the addition of the in-line hemofilter. The use of a smaller dimension pediatric oxygenator resulted in greater hemolysis and a higher pressure gradient. This may indicate that the increased shear forces augment ECMO-induced hemolysis.
authors.affiliation: From the *Division of Pediatric Critical Care, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina; †Department of Perfusion, Duke University Hospital, Durham, North Carolina; and ‡Department of Respiratory Care, Duke University Hospital, Durham, North Carolina.
authors.forename: Duane C
authors.initials: DC
authors.lastname: Williams
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Turi
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hornik
authors.forename: Desiree K
authors.initials: DK
authors.lastname: Bonadonna
authors.forename: Walter L
authors.initials: WL
authors.lastname: Williford
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Walczak
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Watt
authors.forename: Ira M
authors.initials: IM
authors.lastname: Cheifetz
mesh_terms: D000328:Adult; D002648:Child; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000295:instrumentation; D006440:Hemofiltration / Q000009:adverse effects / Q000295:instrumentation; D006454:Hemoglobins / Q000378:metabolism; D006461:Hemolysis; D006801:Humans; D066298:In Vitro Techniques; D010107:Oxygenators, Membrane / Q000009:adverse effects*; D010949:Plasma / Q000378:metabolism; D011312:Pressure
chemical_list: D006454:Hemoglobins