Plasma Free Hemoglobin Is an Independent Predictor of Mortality among Patients on Extracorporeal Membrane Oxygenation Support

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. We performed a retrospective observational study of...

Celý popis

Uložené v:

Podrobná bibliografia
Vydané v:	PloS one Ročník 10; číslo 4; s. e0124034
Hlavní autori:	Omar, Hesham R., Mirsaeidi, Mehdi, Socias, Stephanie, Sprenker, Collin, Caldeira, Christiano, Camporesi, Enrico M., Mangar, Devanand
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Public Library of Science 22.04.2015 Public Library of Science (PLoS)
Predmet:	Acids Aged Analysis Anesthesiology Biomarkers - blood Blood Transfusion Cardiac patients Cardiomyopathies - blood Cardiomyopathies - diagnosis Cardiomyopathies - mortality Cardiomyopathies - therapy Comorbidity Complications Confidence intervals Demographic variables Demographics Demography Extracorporeal membrane oxygenation Extracorporeal Membrane Oxygenation - mortality Female Hazard assessment Heart surgery Hemoglobin Hemoglobins Hemoglobins - metabolism Hemolysis Hospital Mortality Hospitals Humans Implantation Laboratories Lactic acid Lactic Acid - blood Lung Transplantation - mortality Male Males Middle Aged Mortality Multiple organ dysfunction syndrome Observational studies Oxygenation Patient outcomes Patients Plasma Prognosis Proportional Hazards Models Respiratory Insufficiency - blood Respiratory Insufficiency - diagnosis Respiratory Insufficiency - mortality Respiratory Insufficiency - therapy Respiratory therapy Retrospective Studies Shock, Cardiogenic - blood Shock, Cardiogenic - diagnosis Shock, Cardiogenic - mortality Shock, Cardiogenic - therapy Survival Analysis Tertiary Healthcare Time Factors Transfusion Transplants & implants Weaning Florida United States > US
ISSN:	1932-6203, 1932-6203
On-line prístup:	Získať plný text
Tagy:	Pridať tag Žiadne tagy, Buďte prvý, kto otaguje tento záznam!

Popis
Shrnutí:	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. 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 in-hospital 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. 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). 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.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 Competing Interests: The authors would like to declare that authors Enrico M. Camporesi and Collin Sprenker are affiliated with Florida Gulf to Bay Anesthesiology Associates (FGTBA). However, this institution has not played any role in the design or funding of the manuscript. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. Conceived and designed the experiments: HRO MM EMC DM CC. Performed the experiments: HRO MM EMC DM CC CS. Analyzed the data: MM HRO EMC. Wrote the paper: HRO MM. Critical revision of the manuscript for important intellectual content: MM SS CC DM EMC.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0124034