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Circuit Oxygenator Contributes to Extracorporeal Membrane Oxygenation–Induced Hemolysis

2014; Lippincott Williams & Wilkins; Volume: 61; Issue: 2 Linguagem: Inglês

10.1097/mat.0000000000000173

1538-943X

Duane C. Williams, Jennifer L. Turi, Christoph P. Hornik, Desiree Bonadonna, Walter L. Williford, Richard Walczak, Kevin M. Watt, Ira M. Cheifetz,

Heart Failure Treatment and Management

Hemolysis can occur as a consequence of extracorporeal membrane oxygenation (ECMO) and is associated with increased mortality and morbidity. Shear stress generated by flow through the circuit and oxygenator is believed to cause ECMO-induced hemolysis. We hypothesize that either a smaller dimension oxygenator or an in-line hemofilter will increase ECMO-associated hemolysis. Circuits were configured with a Quadrox-D Adult oxygenator (surface area 1.8 m2), Quadrox-iD Pediatric oxygenator (surface area 0.8 m2), or Quadrox-D Adult oxygenator with an in-line hemofilter (N = 4) and ran for 6 hours. Samples were collected hourly from the ECMO circuit and a time-based hemolysis control. Plasma hemoglobin levels were assayed. Circuit-induced hemolysis at each time point was defined as the change in plasma hemoglobin standardized to the time-based hemolysis control. Plasma hemoglobin increased with the use of the smaller dimension pediatric oxygenator as compared with the adult oxygenator when controlling for ECMO run time (p = 0.02). Furthermore, there was a greater pressure gradient with the smaller dimension pediatric oxygenator (p < 0.05). Plasma hemoglobin did not change with the addition of the in-line hemofilter. The use of a smaller dimension pediatric oxygenator resulted in greater hemolysis and a higher pressure gradient. This may indicate that the increased shear forces augment ECMO-induced hemolysis.