Circuit oxygenator contributes to extracorporeal membrane oxygenation-induced hemolysis

ASAIO J. 2015 Mar-Apr;61(2):190-5. doi: 10.1097/MAT.0000000000000173.

Abstract

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 m), Quadrox-iD Pediatric oxygenator (surface area 0.8 m), 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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Child
  • Equipment Design
  • Extracorporeal Membrane Oxygenation / adverse effects*
  • Extracorporeal Membrane Oxygenation / instrumentation
  • Hemofiltration / adverse effects
  • Hemofiltration / instrumentation
  • Hemoglobins / metabolism
  • Hemolysis*
  • Humans
  • In Vitro Techniques
  • Oxygenators, Membrane / adverse effects*
  • Plasma / metabolism
  • Pressure

Substances

  • Hemoglobins