Costantini Silvia, Belliato Mirko, Ferrari Fiorenza, Gazzaniga Giulia, Ravasi Marta, Manera Miriam, De Piero Maria Elena, Curcelli Antonio, Cardinale Alessandra, Lorusso Roberto
Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, 19001University of Pavia, Pavia, Italy.
UOC Anestesia e Rianimazione II Cardiopolmonare, 18631Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Perfusion. 2023 Apr;38(3):609-621. doi: 10.1177/02676591211073768. Epub 2022 Feb 26.
Extracorporeal membrane oxygenation (ECMO)-associated hemolysis still represents a serious complication. The present study aimed to investigate those predictive factors, such as flow rates, the use of anticoagulants, and circuit connected dialysis, that might play a pivotal role in hemolysis in adult patients.
This is a retrospective single-center case series of 35 consecutive adult patients undergoing veno-venous ECMO support at our center between April 2014 and February 2020. Daily plasma-free hemoglobin (pfHb) and haptoglobin (Hpt) levels were chosen as hemolysis markers and they were analyzed along with patients' characteristics, daily laboratory findings, and corresponding ECMO system variables, as well as continuous renal replacement therapy (CRRT) when administered, looking for factors influencing their trends over time.
Among the many settings related to the ECMO support, the presence of CRRT connected to the ECMO circuit has been found associated with both higher daily pfHb levels and lower Hpt levels. After correction for potential confounders, hemolysis was ascribable to circuit-related variables, in particular the membrane oxygenation dead space was associated with an Hpt reduction (B = -215.307, = 0.004). Moreover, a reduction of ECMO blood flow by 1 L/min has been associated with a daily Hpt consumption of 93.371 mg/dL ( = 0.001).
Technical-induced hemolysis during ECMO should be monitored not only when suspected but also during quotidian management and check-ups. While considering the clinical complexity of patients on ECMO support, clinicians should not only be aware of and anticipate possible circuitry malfunctions or inadequate flow settings, but they should also take into account the effects of an ECMO circuit-connected CRRT, as an equally important key factor triggering hemolysis.
体外膜肺氧合（ECMO）相关的溶血仍然是一种严重的并发症。本研究旨在调查那些可能在成年患者溶血中起关键作用的预测因素，如流速、抗凝剂的使用以及回路连接透析。
这是一项回顾性单中心病例系列研究，纳入了2014年4月至2020年2月期间在本中心接受静脉-静脉ECMO支持的35例连续成年患者。选择每日血浆游离血红蛋白（pfHb）和触珠蛋白（Hpt）水平作为溶血标志物，并将其与患者特征、每日实验室检查结果、相应的ECMO系统变量以及进行连续性肾脏替代治疗（CRRT）时的情况进行分析，以寻找影响其随时间变化趋势的因素。
在与ECMO支持相关的众多因素中，发现与ECMO回路相连的CRRT的存在与每日较高的pfHb水平和较低的Hpt水平相关。在对潜在混杂因素进行校正后，溶血可归因于与回路相关的变量，特别是膜氧合死腔与Hpt降低相关（B = -215.307，P = 0.004）。此外，ECMO血流量每减少1 L/min与每日Hpt消耗93.371 mg/dL相关（P = 0.001）。
ECMO期间由技术引起的溶血不仅应在怀疑时进行监测，还应在日常管理和检查期间进行监测。在考虑接受ECMO支持患者的临床复杂性时，临床医生不仅应意识到并预测可能的回路故障或流量设置不当，还应考虑与ECMO回路相连的CRRT的影响，因为它是引发溶血的同样重要的关键因素。
