Introduction: Intravascular hemolysis is a known complication of pediatric extracorporeal membrane oxygenation (ECMO) and an independent predictor of mortality. Resulting elevation in plasma free hemoglobin (PFH) has been associated with increased risk for acute kidney injury. Methods: We measured PFH in plasma from pediatric ECMO patients enrolled in the Biomarkers of Brain Injury in Critically-Ill Children on ECMO (BEAM) multicenter prospective observational study. Samples were collected daily for the first 5 days of ECMO support, and every third day thereafter, with a last sample at the time of decannulation. The primary outcome for this analysis was major kidney adverse events (MAKE) at hospital discharge (composite of death, dialysis dependence or persistent kidney dysfunction). Results: PFH was measured in 1037 samples in 218 study participants of which 51% were 100 mg/dL at any time point during the ECMO course was associated with 2.04 times higher hazard of MAKE at hospital discharge (95% CI: 1.30, 3.01), after adjusting for age and primary ECMO indication. Conclusions: In this prospective study with standardized collection of blood samples, elevated PFH levels were associated with increased risk of MAKE at hospital discharge in pediatric patients on ECMO support. Methods to mitigate or reduce hemolysis may lead to improved outcomes in this high-risk patient population.
Hwang et al. (Sun,) studied this question.