Plasma Free Hemoglobin Is a Predictor of Acute Renal Failure During Adult Venous-Arterial Extracorporeal Membrane Oxygenation Support

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• 作者：Lin Lyu ; MD ; Cun Long ; MD ; Feilong Hei ; MD ; PhD ; Bingyang Ji ; MD ; PhD ; Jinping Liu ; MD ; PhD ; Kun Yu ; MD ; PhD ; Liang Chen ; MD ; Jingxin Yao ; MD ; Qiang Hu ; MD ; Jinxiao Hu ; MD ; Guodong Gao ; MD ; PhD ; ^{gaoguodongfw@163.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：acute renal failure ; extracorporeal membrane oxygenation ; plasma free hemoglobin
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：30
• 期：4
• 页码：891-895
• 全文大小：209 K

文摘

Hemolysis is a common and severe complication during extracorporeal membrane oxygenation (ECMO). Increased plasma free hemoglobin (PFHb) is related to renal injury. The aim of this study was to investigate whether increased PFHb during adult venous-arterial ECMO was associated with acute renal failure (ARF).

Design

A retrospective, observational, single-center study.

Setting

Fuwai Hospital in Beijing, China.

Participants

The study comprised 84 venous-arterial ECMO patients.

Interventions

None.

Measurements and Main Results

A total of 84 consecutive adult patients (≥18 years) with cardiac diseases requiring venous-arterial ECMO support were studied retrospectively. Demographics of patients, clinical and ECMO characteristics, and PFHb level were collected within the first 3 days after ECMO. ARF was defined as a≥300% rise in serum creatinine from baseline or application of dialysis. Repeated measurement analysis of variance revealed that the main effect for the non-ARF group and ARF group in PFHb (p = 0.002) was significant. A significant main effect for time points (p<0.001) and time×group interaction (p = 0.014) in PFHb was obtained. In a multiple logistic regression model, peak PFHb during ECMO (odds ratio 1.052, 95% confidence interval 1.016-1.089, p = 0.005) was a risk factor for ARF during ECMO and patients who underwent heart transplantation (odds ratio 0.240, 95% confidence interval 0.060-0.964, p = 0.044) experienced less ARF. There was a linear correlation between peak serum creatinine and peak PFHb (Spearman’s r = 0.223, p = 0.042).

Conclusions

Increased PFHb is a predictor of ARF among adult patients on venous-arterial ECMO support.