Issue |
J Extra Corpor Technol
Volume 50, Number 4, December 2018
|
|
---|---|---|
Page(s) | 217 - 224 | |
DOI | https://doi.org/10.1051/ject/201850217 | |
Published online | 15 December 2018 |
Original Articles
Impact of Hemolysis on Acute Kidney Injury and Mortality in Children Supported with Cardiac Extracorporeal Membrane Oxygenation
* Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
† Section of Pediatric Critical Care, University of Tennessee College of Medicine, Chattanooga, Tennessee
‡ Departments of Internal Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
§ Cardiovascular Perfusion, Children’s of Alabama, Birmingham, Alabama
‖ Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, Alabama
¶ Department of Pediatrics, Section of Cardiology, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
** Cardiac Intensive Care Unit, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Address correspondence to: Santiago Borasino, MD, Associate Professor of Pediatrics, Division of Cardiology, Section of Cardiac Critical Care, University of Alabama at Birmingham, 1600 5th Avenue South, Children’s Park Place South, Suite 210, Birmingham, AL 35233. E-mail: sborasino@peds.uab.edu
Received:
22
March
2018
Accepted:
25
September
2018
Intravascular hemolysis with elevated plasma-free hemoglobin (PFH) complicates extracorporeal membrane oxygenation (ECMO). In 50 consecutive pediatric cardiac patients requiring ECMO, we sought to describe the relationship between PFH and clinical outcomes; primary outcomes were acute kidney injury (AKI) and prolonged (>14 days) renal replacement therapy (RRT). Median age was 35 days, median weight 3.9 kg, and median ECMO duration 4.2 days. Seventy-eight percent (39/50) weaned off ECMO; survival to discharge was 50% (25/50). Seventy percent (35/50) had AKI on ECMO. Seventy-seven percent (30/39) required RRT post-ECMO; median duration was 5.2 days (0, 14.2). Prolonged RRT was associated with higher daily PFH (67.5 mg/dL [54.1, 102.5] vs. 46.7 mg/dL [40, 72.6], p = .025) and higher peak PFH (120 mg/dL [90, 200] vs. 60 mg/dL [40, 135], p = .016). After adjusting for ECMO duration and oliguria/elevated creatinine on ECMO day 0, peak PFH >90 mg/dL was associated with prolonged RRT (operating room [OR] = 18, confidence interval [CI] 1.9–167.8). Patients who died had higher daily PFH (65 mg/dL [51.6, 111.7] vs. 42.5 mg/dL [37.5, 60], p = .0040). Adjusting for ECMO duration and blood product administration, daily PFH >53 mg/dL was associated with mortality (OR 4.8, CI 1.01–23.3). Elevated PFH during pediatric cardiac ECMO is associated with prolonged RRT and non-survival to discharge. Initiatives to decrease PFH burden may improve clinical outcomes.
Key words: hemolysis / acute kidney injury / renal replacement therapy / children / cardiac extracorporeal membrane oxygenation
© 2018 AMSECT
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