Plasma free hemoglobin is an independent predictor of mortality among patients on extracorporeal membrane oxygenation support

Hesham R. Omar, Mehdi Mirsaeidi, Stephanie Socias, Collin Sprenker, Christiano Caldeira, Enrico M. Camporesi, Devanand Mangar

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background: Hemolysis is common in all extracorporeal circuits as evident by the elevated plasma free hemoglobin (PFHb) level. We investigated whether increased hemolysis during extracorporeal membrane oxygenation (ECMO) is an independent mortality predictor. Methods: We performed a retrospective observational study of consecutive subjects who received ECMO at a tertiary care facility from 2007-2013 to investigate independent predictors of inhospital mortality. We examined variables related to patient demographics, comorbidities, markers of hemolysis, ECMO characteristics, transfusion requirements, and complications. 24-hour PFHb> 50 mg/dL was used as a marker of severe hemolysis. Results: 154 patients received ECMO for cardiac (n= 115) or pulmonary (n=39) indications. Patients' mean age was 51 years and 75.3% were males. Compared to nonsurvivors, survivors had lower pre-ECMO lactic acid (p=0.026), lower 24-hour lactic acid (p=0.023), shorter ECMO duration (P=0.01), fewer RBC transfusions on ECMO (p=0.008) and lower level of PFHb 24-hours post ECMO implantation (p=0.029). 24-hour PFHb> 50 mg/dL occurred in 3.9% versus 15.5% of survivors and nonsurvivors, respectively, p=0.002. A Cox proportional hazard analysis identified PFHb> 50 mg/dL 24-hours post ECMO as an independent predictor of mortality (OR= 3.4, 95% confidence interval: 1.3 - 8.8, p= 0.011). Conclusion: PFHb> 50 mg/dL checked 24-hour post ECMO implantation is a useful tool to predict mortality. We propose the routine checking of PFHb 24-hours after ECMO initiation for early identification and treatment of the cause of hemolysis.

Original languageEnglish (US)
Article numbere0124034
JournalPLoS One
Volume10
Issue number4
DOIs
StatePublished - Apr 22 2015
Externally publishedYes

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Extracorporeal Membrane Oxygenation
Oxygenation
hemoglobin
Hemoglobins
hemolysis
Membranes
Plasmas
Mortality
Hemolysis
lactic acid
hazard characterization
Survivors
Lactic Acid
observational studies
confidence interval
erythrocytes
demographic statistics
lungs
Tertiary Healthcare
Hospital Mortality

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Plasma free hemoglobin is an independent predictor of mortality among patients on extracorporeal membrane oxygenation support. / Omar, Hesham R.; Mirsaeidi, Mehdi; Socias, Stephanie; Sprenker, Collin; Caldeira, Christiano; Camporesi, Enrico M.; Mangar, Devanand.

In: PLoS One, Vol. 10, No. 4, e0124034, 22.04.2015.

Research output: Contribution to journalArticle

Omar, Hesham R. ; Mirsaeidi, Mehdi ; Socias, Stephanie ; Sprenker, Collin ; Caldeira, Christiano ; Camporesi, Enrico M. ; Mangar, Devanand. / Plasma free hemoglobin is an independent predictor of mortality among patients on extracorporeal membrane oxygenation support. In: PLoS One. 2015 ; Vol. 10, No. 4.
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abstract = "Background: Hemolysis is common in all extracorporeal circuits as evident by the elevated plasma free hemoglobin (PFHb) level. We investigated whether increased hemolysis during extracorporeal membrane oxygenation (ECMO) is an independent mortality predictor. Methods: We performed a retrospective observational study of consecutive subjects who received ECMO at a tertiary care facility from 2007-2013 to investigate independent predictors of inhospital mortality. We examined variables related to patient demographics, comorbidities, markers of hemolysis, ECMO characteristics, transfusion requirements, and complications. 24-hour PFHb> 50 mg/dL was used as a marker of severe hemolysis. Results: 154 patients received ECMO for cardiac (n= 115) or pulmonary (n=39) indications. Patients' mean age was 51 years and 75.3{\%} were males. Compared to nonsurvivors, survivors had lower pre-ECMO lactic acid (p=0.026), lower 24-hour lactic acid (p=0.023), shorter ECMO duration (P=0.01), fewer RBC transfusions on ECMO (p=0.008) and lower level of PFHb 24-hours post ECMO implantation (p=0.029). 24-hour PFHb> 50 mg/dL occurred in 3.9{\%} versus 15.5{\%} of survivors and nonsurvivors, respectively, p=0.002. A Cox proportional hazard analysis identified PFHb> 50 mg/dL 24-hours post ECMO as an independent predictor of mortality (OR= 3.4, 95{\%} confidence interval: 1.3 - 8.8, p= 0.011). Conclusion: PFHb> 50 mg/dL checked 24-hour post ECMO implantation is a useful tool to predict mortality. We propose the routine checking of PFHb 24-hours after ECMO initiation for early identification and treatment of the cause of hemolysis.",
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AU - Omar, Hesham R.

AU - Mirsaeidi, Mehdi

AU - Socias, Stephanie

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AU - Caldeira, Christiano

AU - Camporesi, Enrico M.

AU - Mangar, Devanand

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N2 - Background: Hemolysis is common in all extracorporeal circuits as evident by the elevated plasma free hemoglobin (PFHb) level. We investigated whether increased hemolysis during extracorporeal membrane oxygenation (ECMO) is an independent mortality predictor. Methods: We performed a retrospective observational study of consecutive subjects who received ECMO at a tertiary care facility from 2007-2013 to investigate independent predictors of inhospital mortality. We examined variables related to patient demographics, comorbidities, markers of hemolysis, ECMO characteristics, transfusion requirements, and complications. 24-hour PFHb> 50 mg/dL was used as a marker of severe hemolysis. Results: 154 patients received ECMO for cardiac (n= 115) or pulmonary (n=39) indications. Patients' mean age was 51 years and 75.3% were males. Compared to nonsurvivors, survivors had lower pre-ECMO lactic acid (p=0.026), lower 24-hour lactic acid (p=0.023), shorter ECMO duration (P=0.01), fewer RBC transfusions on ECMO (p=0.008) and lower level of PFHb 24-hours post ECMO implantation (p=0.029). 24-hour PFHb> 50 mg/dL occurred in 3.9% versus 15.5% of survivors and nonsurvivors, respectively, p=0.002. A Cox proportional hazard analysis identified PFHb> 50 mg/dL 24-hours post ECMO as an independent predictor of mortality (OR= 3.4, 95% confidence interval: 1.3 - 8.8, p= 0.011). Conclusion: PFHb> 50 mg/dL checked 24-hour post ECMO implantation is a useful tool to predict mortality. We propose the routine checking of PFHb 24-hours after ECMO initiation for early identification and treatment of the cause of hemolysis.

AB - Background: Hemolysis is common in all extracorporeal circuits as evident by the elevated plasma free hemoglobin (PFHb) level. We investigated whether increased hemolysis during extracorporeal membrane oxygenation (ECMO) is an independent mortality predictor. Methods: We performed a retrospective observational study of consecutive subjects who received ECMO at a tertiary care facility from 2007-2013 to investigate independent predictors of inhospital mortality. We examined variables related to patient demographics, comorbidities, markers of hemolysis, ECMO characteristics, transfusion requirements, and complications. 24-hour PFHb> 50 mg/dL was used as a marker of severe hemolysis. Results: 154 patients received ECMO for cardiac (n= 115) or pulmonary (n=39) indications. Patients' mean age was 51 years and 75.3% were males. Compared to nonsurvivors, survivors had lower pre-ECMO lactic acid (p=0.026), lower 24-hour lactic acid (p=0.023), shorter ECMO duration (P=0.01), fewer RBC transfusions on ECMO (p=0.008) and lower level of PFHb 24-hours post ECMO implantation (p=0.029). 24-hour PFHb> 50 mg/dL occurred in 3.9% versus 15.5% of survivors and nonsurvivors, respectively, p=0.002. A Cox proportional hazard analysis identified PFHb> 50 mg/dL 24-hours post ECMO as an independent predictor of mortality (OR= 3.4, 95% confidence interval: 1.3 - 8.8, p= 0.011). Conclusion: PFHb> 50 mg/dL checked 24-hour post ECMO implantation is a useful tool to predict mortality. We propose the routine checking of PFHb 24-hours after ECMO initiation for early identification and treatment of the cause of hemolysis.

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