title: Technical-Induced Hemolysis in Patients with Respiratory Failure Supported with Veno-Venous ECMO - Prevalence and Risk Factors.
abstract: The aim of the study was to explore the prevalence and risk factors for technical-induced hemolysis in adults supported with veno-venous extracorporeal membrane oxygenation (vvECMO) and to analyze the effect of hemolytic episodes on outcome. This was a retrospective, single-center study that included 318 adult patients (Regensburg ECMO Registry, 2009-2014) with acute respiratory failure treated with different modern miniaturized ECMO systems. Free plasma hemoglobin (fHb) was used as indicator for hemolysis. Throughout a cumulative support duration of 4,142 days on ECMO only 1.7% of the fHb levels were above a critical value of 500 mg/l. A grave rise in fHb indicated pumphead thrombosis (n = 8), while acute oxygenator thrombosis (n = 15) did not affect fHb. Replacement of the pumphead normalized fHb within two days. Neither pump or cannula type nor duration on the first system was associated with hemolysis. Multiple trauma, need for kidney replacement therapy, increased daily red blood cell transfusion requirements, and high blood flow (3.0-4.5 L/min) through small-sized cannulas significantly resulted in augmented blood cell trauma. Survivors were characterized by lower peak levels of fHb [90 (60, 142) mg/l] in comparison to non-survivors [148 (91, 256) mg/l, p≤0.001]. In conclusion, marked hemolysis is not common in vvECMO with modern devices. Clinically obvious hemolysis often is caused by pumphead thrombosis. High flow velocity through small cannulas may also cause technical-induced hemolysis. In patients who developed lung failure due to trauma, fHb was elevated independantly of ECMO. In our cohort, the occurance of hemolysis was associated with increased mortality.
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Karla
authors.initials: K
authors.lastname: Lehle
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.affiliation: Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Zeman
authors.affiliation: Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Lunz
authors.affiliation: Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Lubnow
authors.affiliation: Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Wendel
authors.affiliation: Department of Cardiothoracic Surgery, Southampton University Hospital Trust, Southampton, United Kingdom.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Göbölös
authors.affiliation: Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.affiliation: Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
mesh_terms: D000328:Adult; D017707:Erythrocyte Transfusion; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods; D006439:Hemodynamics; D006461:Hemolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy; D012131:Respiratory Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome