Elevated carboxyhaemoglobin as a novel indicator for extracorporeal membrane haemolysis and oxygenator exchange

Hoffman, Kenneth R.; Burrell, Aidan; Diehl, Arne; Butt, Warwick

doi:10.1186/s13054-021-03582-w

Cited by 13 publications

(16 citation statements)

References 4 publications

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“…Such findings are similar to the report by Hoffman et al (7), who described the evolution of HbCO before and after oxygenator replacement, and Kimura et al, who showed an HbCO increase on ECMO and a significant reduction after ECMO removal (11). Such an increased level of HbCO might be an indicator of impending oxygenator dysfunction, able to both induce thromboembolic events and increase mortality (6)(7)(8). Importantly, oxygenator lifespan was not associated with HbCO, suggesting that a functional oxygenator will not raise HbCO.…”

Section: Discussionsupporting

confidence: 88%

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Use of Carboxyhemoglobin as an Early Sign of Oxygenator Dysfunction in Patients Supported by Extracorporeal Membrane Oxygenation

et al. 2022

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IntroductionPlasma free hemoglobin is the gold standard for monitoring hemolysis in extracorporeal membrane oxygenation (ECMO) but its routine use has some limitations. Carboxyhemoglobin (HbCO) is also a marker of intravascular hemolysis. We aimed to investigate HbCO as a marker of both hemolysis and oxygenator dysfunction in patients supported by ECMO.MethodsRetrospective analysis of patients on ECMO in an adult ICU in a tertiary hospital. HbCO was recorded every 6 h in the 48 h before and after oxygenator change in adult patients on ECMO support with an oxygenator dysfunction and replacement.ResultsThe investigation of 27 oxygenators replacements in 19 patients demonstrated that HbCO values progressively increased over time and then significantly decreased after oxygenator change. Median oxygenator lifespan was 14 days [interquartile range (IQR) 8–21] and there was no correlation between HbCO and oxygenator lifespan [Spearman coefficient 0.23 (p = 0.23)]. HbCO values at oxygenator change [HbCO median 2.7 (IQR 2.5–3.5)] were significantly higher than the HbCO values 1 week before [HbCO median 2.07 (IQR 1.86–2.8)] (p value < 0.001).ConclusionOur data highlight the potential role of HbCO as a novel marker for ECMO oxygenator dysfunction.

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Section: Discussionsupporting

confidence: 88%

“…Then, carbon monoxide binds with hemoglobin to form HbCO. There are several case reports of elevated HbCO in cases of hemolysis and oxygenator dysfunction in the current literature (6)(7)(8). However, there are currently no studies looking at the use of HbCO values as an early additional marker of ECMO oxygenator dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Use of Carboxyhemoglobin as an Early Sign of Oxygenator Dysfunction in Patients Supported by Extracorporeal Membrane Oxygenation

et al. 2022

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“…In the ECMO collective specifically, CO-Hb might be elevated due to hemolysis [ 12 , 15 , 16 ]. Hemolysis derived CO-Hb was especially discussed in the context of CO-Hb levels above 7% [ 13 , 15 ]. In our study, we see all four markers or hemolysis investigated escalating alongside CO-Hb.…”

Section: Discussionmentioning

confidence: 99%

“…Several reports describe elevated CO-Hb concentrations in patients on ECMO [ 12 , 13 , 14 , 15 , 16 ]. Increased levels of CO-Hb up to a certain degree are to be expected in the ECMO collective, since hemolysis is a common complication of extracorporeal circulation and as discussed above hemolysis is a source of endogenous CO. A recent review of hemolysis in VV ECMO reported an incidence of significant hemolysis in up to 29% of investigated patients [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry

et al. 2022

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Background: Patients supported with extracorporeal membrane oxygenation (ECMO) may develop elevated carboxyhemoglobin (CO-Hb), a finding described in the context of hemolysis. Clinical relevance of elevated CO-Hb in ECMO is unclear. We therefore investigated the prognostic relevance of CO-Hb during ECMO support. Methods: Data derives from a retrospective single-center registry study. All ECMO patients in a medical ICU from October 2010 through December 2019 were considered. Peak arterial CO-Hb value during ECMO support and median CO-Hb values determined by point-of-care testing for distinct time intervals were determined. Groups were divided by CO-Hb (<2% or ≥2%). The primary endpoint was hospital survival. Results: A total of 729 patients with 59,694 CO-Hb values met the inclusion criteria. Median age (IQR) was 59 (48–68) years, 221/729 (30.3%) were female, and 278/729 (38.1%) survived until hospital discharge. Initial ECMO configuration was veno-arterial in 431/729 (59.1%) patients and veno-venous in 298/729 (40.9%) patients. Markers for hemolysis (lactate dehydrogenase, bilirubin, hemolysis index, and haptoglobin) all correlated significantly with higher CO-Hb (p < 0.001, respectively). Hospital survival was significantly higher in patients with CO-Hb < 2% compared to CO-Hb ≥ 2%, evaluating time periods 24–48 h (48.6% vs. 35.2%, p = 0.003), 48–72 h (51.5% vs. 36.8%, p = 0.003), or >72 h (56.9% vs. 31.1%, p < 0.001) after ECMO cannulation. Peak CO-Hb was independently associated with lower hospital survival after adjustment for confounders. Conclusions: In ECMO, CO-Hb correlates with hemolysis and hospital survival. If high CO-Hb measured should trigger a therapeutic intervention in order to reduce hemolysis has to be investigated in prospective trials.

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“…As opposed to previous reports, ours did not find a statistical association between coagulopathy or changes of carbon dioxide and ICRH. We used COHb as a surrogate for hemolysis [ 24 , 25 ]. Surprisingly, we found lower levels of COHb to be associated with ICRH.…”

Section: Discussionmentioning

confidence: 99%

Association of COVID-19 with Intracranial Hemorrhage during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A 10-Year Retrospective Observational Study

Pantel

Roedl

Jarczak

et al. 2021

JCM

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Extracorporeal membrane oxygenation (ECMO) is potentially lifesaving for patients with acute respiratory distress syndrome (ARDS) but may be accompanied by serious adverse events, including intracranial hemorrhage (ICRH). We hypothesized that ICRH occurs more frequently in patients with COVID-19 than in patients with ARDS of other etiologies. We performed a single-center retrospective analysis of adult patients treated with venovenous (vv-) ECMO for ARDS between January 2011 and April 2021. Patients were included if they had received a cranial computed tomography (cCT) scan during vv-ECMO support or within 72 h after ECMO removal. Cox regression analysis was used to identify factors associated with ICRH. During the study period, we identified 204 patients with vv-ECMO for ARDS, for whom a cCT scan was available. We observed ICRH in 35.4% (n = 17/48) of patients with COVID-19 and in 16.7% (n = 26/156) of patients with ARDS attributable to factors other than COVID-19. COVID-19 (HR: 2.945; 95%; CI: 1.079–8.038; p = 0.035) and carboxyhemoglobin (HR: 0.330; 95%; CI: 0.135–0.806; p = 0.015) were associated with ICRH during vv-ECMO. In patients receiving vv-ECMO, the incidence of ICRH is doubled in patients with COVID-19 compared to patients suffering from ARDS attributable to other causes. More studies on the association between COVID-19 and ICRH during vv-ECMO are urgently needed to identify risk patterns and targets for potential therapeutic interventions.

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Elevated carboxyhaemoglobin as a novel indicator for extracorporeal membrane haemolysis and oxygenator exchange

Cited by 13 publications

References 4 publications

Use of Carboxyhemoglobin as an Early Sign of Oxygenator Dysfunction in Patients Supported by Extracorporeal Membrane Oxygenation

Use of Carboxyhemoglobin as an Early Sign of Oxygenator Dysfunction in Patients Supported by Extracorporeal Membrane Oxygenation

Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry

Association of COVID-19 with Intracranial Hemorrhage during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A 10-Year Retrospective Observational Study

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