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Significance of hemolysis on extracorporeal life support after cardiac surgery in children

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Abstract

Hemolysis is common during extracorporeal life support (ECLS). Elevated levels of circulating plasma free hemoglobin (FHb) has been linked to the development of hemoglobinuria nephropathy. Its clinical significance in patients receiving ECLS remains unknown. Medical records of 104 children <3 years old who required ECLS after repair of congenital heart disease were reviewed. Forty-two patients required continuous renal replacement therapy (CRRT) during ECLS (CRRT group), and 62 patients did not (no-CRRT group). For all patients, FHb level and the degree of fluid overload at the end of ECLS predicted the mortality rate during ECLS. Compared with the no-CRRT group, the CRRT group had a higher mortality rate during ECLS, a higher peak FHb level during ECLS, a higher FHb level at the end of ECLS, and more days of ECLS. In the CRRT group, the FHb level at the end of ECLS predicted death during ECLS. In the no-CRRT group, the peak FHb level was associated with a worse renal function. In conclusion, elevated FHb levels were associated with renal dysfunction and death during ECLS in children undergoing cardiac surgery. Further studies are needed to elucidate the cause–effect relationship in our findings.

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Authors and Affiliations

  1. Department of Pediatrics, Duke University Medical Center, Durham, NC, USA

    Rasheed Gbadegesin

  2. Department of Computer Sciences, University of Michigan, Ann Arbor, MI, USA

    Shuang Zhao

  3. Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA

    John Charpie

  4. Department of Pediatrics, University of Iowa, Iowa City, IA, USA

    Patrick D. Brophy

  5. The Office of Clinical Research Administration and the Clinical Study Center, Ohio State University, Columbus, OH, USA

    William E. Smoyer

  6. Department of Pediatric Nephrology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA

    Jen-Jar Lin

Authors
  1. Rasheed Gbadegesin
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  2. Shuang Zhao
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  3. John Charpie
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  4. Patrick D. Brophy
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  5. William E. Smoyer
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  6. Jen-Jar Lin
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Correspondence to Jen-Jar Lin.

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Gbadegesin, R., Zhao, S., Charpie, J. et al. Significance of hemolysis on extracorporeal life support after cardiac surgery in children. Pediatr Nephrol 24, 589–595 (2009). https://doi.org/10.1007/s00467-008-1047-z

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  • DOI: https://doi.org/10.1007/s00467-008-1047-z

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