J Pediatr

. 2023 Aug 31;113713.

 doi: 10.1016/j.jpeds.2023.113713. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/37659588/

Hemolysis during Venovenous ECMO in Neonates with Congenital Diaphragmatic Hernia: A Prospective Observational Study

Lotte Lemloh ¹, Bartolomeo Bo ¹, Hannah Ploeger ¹, Ramona Dolscheid-Pommerich ², Andreas Mueller ¹, Florian Kipfmueller ³

Affiliations expand

• PMID: 37659588
• DOI: 10.1016/j.jpeds.2023.113713

Abstract

Objective: To investigate the incidence of hemolysis and its association with outcome in neonates with congenital diaphragmatic hernia (CDH) requiring venovenous extracorporeal membrane oxygenation (ECMO) treatment using a Medos Deltastream circuit with a DP3 pump, a hilite 800 LT oxygenator system, and a ¼” tubing.

Study design: Plasma free hemoglobin (PFH) was prospectively measured once daily during ECMO using spectrophotometric testing. Patients (n=62) were allocated into two groups according to presence or absence of hemolysis. Hemolysis was defined as PFH ≥ 50 mg/dL on at least 2 consecutive days during ECMO treatment. Hemolysis was classified as either moderate with a maximum PFH of 50-100 mg/dL or severe with a maximum PFH >100 mg/dL.

Results: Hemolysis was detected in 14 patients (22.6%). Mortality was 100% in neonates with hemolysis compared with 31.1% in neonates without hemolysis (p<0.001). In 21.4% hemolysis was moderate and in 78.6% severe. Using multivariable analysis, hemolysis (hazard ratio: 6.8; 95%CI: 1.86-24.86) and suprasystemic pulmonary hypertension (hazard ratio: 3.07; 95%CI: 1.01-9.32) were independently associated with mortality. Hemolysis occurred significantly more often using 8 Fr cannulae than 13 Fr cannulae (43% vs. 17%; p=0.039). Cutoff for relative ECMO flow to predict hemolysis were 115 ml/kg/min for patients with 8 Fr cannulae (AUC 0.786, p=0.042) and 100 ml/kg/min for patients with 13 Fr cannulae (AUC 0.840, p<0.001).

Conclusions: Hemolysis in CDH neonates receiving venovenous ECMO is independently associated with mortality.

Keywords: Hemolysis; congenital diaphragmatic hernia; extracorporeal life support; plasma free hemoglobin; venovenous.

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