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Observational Study
. 2015 Apr 22;10(4):e0124034.
doi: 10.1371/journal.pone.0124034. eCollection 2015.

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

Hesham R Omar  1 , Mehdi Mirsaeidi  2 , Stephanie Socias  3 , Collin Sprenker  3 , Christiano Caldeira  4 , Enrico M Camporesi  5 , Devanand Mangar  6
Affiliations
Observational Study

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

Hesham R Omar et al. PLoS One. .

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 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.

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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Conflict of interest statement

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.

Figures

Fig 1
Fig 1. Cox proportional hazard method analysis of predictors of in-hospital mortality for patients receiving extracorporeal membrane oxygenation at Tampa General Hospital from 2007–2013.
Fig 2
Fig 2. Kaplan-Meier cumulative survival curve comparing subjects with plasma free Hb>50 mg/dL or<50 mg/dL checked 24-hour post ECMO initiation for a follow up period of 30 days.
Fig 3
Fig 3. Kaplan-Meier cumulative survival curve comparing subjects with plasma free Hb>50 mg/dL or<50 mg/dL checked 24-hour post ECMO initiation up to 3 years of follow up.
See this image and copyright information in PMC

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