Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)—Comparison of VA- versus VV ECMO
Autor: | Matthias Lubnow, Dirk Lunz, Florian Zeman, Karla Lehle, Maik Foltan, Thomas Mueller, Alois Philipp, Hannah Appelt |
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Rok vydání: | 2020 |
Předmět: |
Male
Blood transfusion Physiology medicine.medical_treatment Cardiovascular Medicine 030204 cardiovascular system & hematology Biochemistry Vascular Medicine 0302 clinical medicine Risk Factors Animal Cells Interquartile range Blood Flow Immune Physiology Medicine and Health Sciences Innate Immune System Multidisciplinary Hematology Middle Aged Thrombosis Clinical Laboratory Sciences Hemolysis Body Fluids Cardiac surgery Blood surgical procedures operative Cardiovascular Diseases Anesthesia Medicine Cytokines Female Anatomy Cellular Types Research Article Adult Platelets medicine.medical_specialty Science Immunology Blood Plasma Catheterization 03 medical and health sciences Extracorporeal Membrane Oxygenation Diagnostic Medicine Extracorporeal membrane oxygenation medicine Humans Blood Transfusion Hemoglobin Blood Coagulation Survival rate Aged Retrospective Studies Blood Cells Coagulation Disorders Transfusion Medicine business.industry Biology and Life Sciences Proteins 030208 emergency & critical care medicine Cell Biology Molecular Development medicine.disease Immune System business Complication Developmental Biology |
Zdroj: | PLoS ONE PLoS ONE, Vol 15, Iss 1, p e0227793 (2020) |
ISSN: | 1932-6203 |
Popis: | Venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) are effective support modalities to treat critically ill patients. ECMO-associated hemolysis remains a serious complication. The aim was to disclose similarities and differences in VA- and VV ECMO-associated hemolysis. This is a retrospective single-center analysis (January 2012 to September 2018) including 1,063 adult consecutive patients (VA, n = 606; VV, n = 457). Severe hemolysis (free plasma hemoglobin, fHb > 500 mg/l) during therapy occurred in 4% (VA) and 2% (VV) (p≤0.001). VV ECMO showed significantly more hemolysis by pump head thrombosis (PHT) compared to VA ECMO (9% vs. 2%; p≤0.001). Pretreatments (ECPR, cardiac surgery) of patients who required VA ECMO caused high fHb pre levels which aggravates the proof of ECMO-induced hemolysis (median (interquartile range), VA: fHb pre: 225.0 (89.3-458.0); VV: fHb pre: 72.0 (42.0-138.0); p≤0.001). The survival rate to discharge from hospital differed depending on ECMO type (40% (VA) vs. 63% (VV); p≤0.001). Hemolysis was dominant in VA ECMO patients, mainly caused by different indications and not by the ECMO support itself. PHT was the most severe form of ECMO-induced hemolysis that occurs in both therapies with low frequency, but more commonly in VV ECMO due to prolonged support time. |
Databáze: | OpenAIRE |
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