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Erlebach R, Buhlmann A, Andermatt R, Seeliger B, Stahl K, Bode C, Schuepbach R, Wendel-Garcia PD, David S. Carboxyhemoglobin predicts oxygenator performance and imminent oxygenator change in extracorporeal membrane oxygenation. Intensive Care Med Exp 2024; 12:41. [PMID: 38656714 PMCID: PMC11043307 DOI: 10.1186/s40635-024-00626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The continuous exposure of blood to a non-biological surface during extracorporeal membrane oxygenation (ECMO) may lead to progressive thrombus formation in the oxygenator, hemolysis and consequently impaired gas exchange. In most centers oxygenator performance is monitored only on a once daily basis. Carboxyhemoglobin (COHb) is generated upon red cell lysis and is routinely measured with any co-oximetry performed to surveille gas exchange and acid-base homeostasis every couple of hours. This retrospective cohort study aims to evaluate COHb in the arterial blood gas as a novel marker of oxygenator dysfunction and its predictive value for imminent oxygenator change. RESULTS Out of the 484 screened patients on ECMO 89, cumulatively requiring 116 oxygenator changes within 1833 patient days, including 19,692 arterial COHb measurements were analyzed. Higher COHb levels were associated with lower post-oxygenator pO2 (estimate for log(COHb): - 2.176 [95% CI - 2.927, - 1.427], p < 0.0001) and with a shorter time to oxygenator change (estimate for log(COHb): - 67.895 [95% CI - 74.209, - 61.542] hours, p < 0.0001). COHb was predictive of oxygenator change within 6 h (estimate for log(COHb): 5.027 [95% CI 1.670, 15.126], p = 0.004). CONCLUSION COHb correlates with oxygenator performance and can be predictive of imminent oxygenator change. Therefore, longitudinal measurements of COHb in clinical routine might be a cheap and more granular candidate for ECMO surveillance that should be further analyzed in a controlled prospective trial design.
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Affiliation(s)
- Rolf Erlebach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Alix Buhlmann
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Rea Andermatt
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Benjamin Seeliger
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Klaus Stahl
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Reto Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Sascha David
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
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Maeda A, Pandey D, Inokuchi R, Spano S, Chaba A, Phongphithakchai A, Eastwood G, Jahanabadi H, Vo H, Seevanayagam S, Motley A, Bellomo R. Carboxyhemoglobin in Cardiac Surgery Patients and Its Association with Risk Factors and Biomarkers of Hemolysis. Anesth Analg 2024:00000539-990000000-00780. [PMID: 38446702 DOI: 10.1213/ane.0000000000006915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Cardiac surgery with cardiopulmonary bypass (CPB) is associated with hemolysis. Yet, there is no easily available and frequently measured marker to monitor this hemolysis. However, carboxyhemoglobin (CO-Hb), formed by the binding of carbon monoxide (a product of heme breakdown) to hemoglobin, may reflect such hemolysis. We hypothesized that CO-Hb might increase after cardiac surgery and show associations with operative risk factors and indirect markers for hemolysis. METHODS We conducted a retrospective descriptive cohort study of data from on-pump cardiac surgery patients. We analyzed temporal changes in CO-Hb levels and applied a generalized linear model to assess patient characteristics associated with peak CO-Hb levels. Additionally, we examined their relationship with red blood cell (RBC) transfusion and bilirubin levels. RESULTS We studied 38,487 CO-Hb measurements in 1735 patients. CO-Hb levels increased significantly after cardiac surgery, reaching a peak CO-Hb level 2.1 times higher than baseline (P < .001) at a median of 17 hours after the initiation of surgery. Several factors were independently associated with higher peak CO-Hb, including age (P < .001), preoperative respiratory disease (P = .001), New York Heart Association Class IV (P = .019), the number of packed RBC transfused (P < .001), and the duration of CPB (P = .002). Peak CO-Hb levels also significantly correlated with postoperative total bilirubin levels (Rho = 0.27, P < .001). CONCLUSIONS CO-Hb may represent a readily obtainable and frequently measured biomarker that has a moderate association with known biomarkers of and risk factors for hemolysis in on-pump cardiac surgery patients. These findings have potential clinical implications and warrant further investigation.
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Affiliation(s)
- Akinori Maeda
- From the Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
- Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan
| | - Dinesh Pandey
- Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Victoria, Australia
- Clinical Analytics and Reporting, Austin Health, Melbourne, Victoria, Australia
| | - Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan
- Department of Clinical Engineering, The University of Tokyo, Tokyo, Japan
| | - Sofia Spano
- From the Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Anis Chaba
- From the Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | | | - Glenn Eastwood
- From the Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Hossein Jahanabadi
- Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Victoria, Australia
- Clinical Analytics and Reporting, Austin Health, Melbourne, Victoria, Australia
| | - Hung Vo
- Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Victoria, Australia
- Clinical Analytics and Reporting, Austin Health, Melbourne, Victoria, Australia
| | - Siven Seevanayagam
- Department of Cardiac Surgery, Austin Hospital, Melbourne, Victoria, Australia
| | - Andrew Motley
- Department of Haematology and Blood Bank, Austin Hospital, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- From the Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia; and
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
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Yoshida T, Sakura T, Shimizu K, Kimura S, Iwasaki T, Kanazawa T, Morimatsu H. Carboxyhemoglobin and Methemoglobin Levels and Hemolysis in Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass. ASAIO J 2023; 69:1099-1105. [PMID: 37788481 DOI: 10.1097/mat.0000000000002044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Hemolysis is a complication of cardiopulmonary bypass (CPB). Carboxyhemoglobin (COHb) and methemoglobin (MetHb) were suggested as potential hemolysis biomarkers. This retrospective study was based on a prospective registry aimed to determine the association of COHb and MetHb levels with hemolysis in pediatric patients <4 years old who underwent cardiac surgery with CPB. Plasma-free hemoglobin (PFH), COHb, and MetHb levels were measured before CPB; every 30 minutes during CPB; and on postoperative days 1, 2, and 3. Patients were classified into hemolysis and nonhemolysis groups based on the maximum PFH levels during CPB. A total of 193 patients were included. No significant difference was observed in the maximum COHb levels during CPB (COHb CPB ) between the hemolysis and nonhemolysis groups (1.2% [interquartile range {IQR} 0.9-1.4%] vs. 1.1% [IQR: 0.9-1.4%]; p = 0.17). The maximum MetHb levels during CPB (MetHb CPB ) were significantly higher in the hemolysis group than in the nonhemolysis group (1.3% [IQR: 1.1-1.5%] vs. 1.2% [IQR: 1.0-1.4%]; p = 0.007). Areas under the receiver operating curves of COHb CPB and MetHb CPB were 0.557 (95% confidence interval: 0.475-0.640) and 0.615 (95% confidence interval: 0.535-0.695), respectively. Therefore, the predictive ability of both hemolysis biomarkers during CPB is limited.
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Affiliation(s)
- Tsubasa Yoshida
- From the Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takanobu Sakura
- From the Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Kazuyoshi Shimizu
- From the Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Satoshi Kimura
- From the Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Tatsuo Iwasaki
- From the Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Tomoyuki Kanazawa
- From the Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Hiroshi Morimatsu
- From the Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
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Brohan O, Liet JM, Dejoie T, Jegard J, Gaultier A, Bourgoin P, Joram N, Chenouard A. Evolution of Carboxyhemoglobin in Children Supported by Extracorporeal Membrane Oxygenation: An Observational Single-Center Study. ASAIO J 2023; 69:879-884. [PMID: 37527636 DOI: 10.1097/mat.0000000000001983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Carboxyhemoglobin (COHb) is potentially a novel marker of hemolysis on extracorporeal membrane oxygenation (ECMO) and may be useful as an indicator for circuit-related complication in adults, but little is known about COHb levels in children. An observational single-center study was performed between January 2018 and December 2021. Fifty-eight children were included and COHb levels were obtained along with routine blood gas analysis before, during, and after ECMO support. From the 6th hour of ECMO support, the COHb level increased relative to the pre-ECMO level, with an adjusted mean difference of 0.44 (95% confidence interval [CI], 0.26-0.62; p < 0.001) and remained higher during ECMO run and within 6 hours after weaning ( p < 0.001). Among the 18 children (31%) who experienced at least one circuit-related complication leading to a circuit change, we observed a significant decrease in COHb levels within 24 hours after the circuit change, compared with the 24 hours before (adjusted mean difference, 0.54%; 95% CI, 0.27-0.80; p < 0.001). The maximal daily COHb level was able to predict circuit-related complications within 24 hours following COHb measurement with an area under the receiver operating characteristic (ROC) curve of 0.85 (95% CI, 0.77-0.92; p < 0.001).
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Affiliation(s)
- Orlane Brohan
- From the Service Réanimation Pédiatrique, CHU Nantes, Nantes Université, Réanimation Pédiatrique, Nantes, France
| | - Jean-Michel Liet
- From the Service Réanimation Pédiatrique, CHU Nantes, Nantes Université, Réanimation Pédiatrique, Nantes, France
| | - Thomas Dejoie
- Laboratoire de Biochimie, CHU Nantes, Nantes Université, Nantes, France
| | - Julien Jegard
- From the Service Réanimation Pédiatrique, CHU Nantes, Nantes Université, Réanimation Pédiatrique, Nantes, France
| | - Aurélie Gaultier
- Direction de la Recherche et de l'innovation, Plateforme de méthodologie et biostatistique, CHU Nantes, Nantes Université, Nantes, France
| | - Pierre Bourgoin
- CHU Nantes, Nantes Université, Département d'Anesthésie, Nantes, France
| | - Nicolas Joram
- From the Service Réanimation Pédiatrique, CHU Nantes, Nantes Université, Réanimation Pédiatrique, Nantes, France
| | - Alexis Chenouard
- From the Service Réanimation Pédiatrique, CHU Nantes, Nantes Université, Réanimation Pédiatrique, Nantes, France
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Bemtgen X, Rilinger J, Holst M, Rottmann F, Lang CN, Jäckel M, Zotzmann V, Benk C, Wengenmayer T, Supady A, Staudacher DL. Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry. Diagnostics (Basel) 2022; 12:diagnostics12071642. [PMID: 35885547 PMCID: PMC9324470 DOI: 10.3390/diagnostics12071642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
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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Affiliation(s)
- Xavier Bemtgen
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.N.L.); (V.Z.); (T.W.); (A.S.); (D.L.S.)
- Correspondence: ; Tel.: +49-(0)761/270-34010
| | - Jonathan Rilinger
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.R.); (M.J.)
| | - Manuel Holst
- Department of Hematology, Oncology, and Stem Cell Transplantation, Faculty of Medicine, Freiburg University Medical Center, 79106 Freiburg, Germany;
| | - Felix Rottmann
- Department of Nephrology, Faculty of Medicine, Freiburg University Medical Center, 79106 Freiburg, Germany;
| | - Corinna N. Lang
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.N.L.); (V.Z.); (T.W.); (A.S.); (D.L.S.)
| | - Markus Jäckel
- Department of Cardiology and Angiology, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (J.R.); (M.J.)
| | - Viviane Zotzmann
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.N.L.); (V.Z.); (T.W.); (A.S.); (D.L.S.)
| | - Christoph Benk
- Department of Cardiovascular Surgery, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Tobias Wengenmayer
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.N.L.); (V.Z.); (T.W.); (A.S.); (D.L.S.)
| | - Alexander Supady
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.N.L.); (V.Z.); (T.W.); (A.S.); (D.L.S.)
- Heidelberg Institute of Global Health, University of Heidelberg, 69117 Heidelberg, Germany
| | - Dawid L. Staudacher
- Interdisciplinary Medical Intensive Care (IMIT), Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (C.N.L.); (V.Z.); (T.W.); (A.S.); (D.L.S.)
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6
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Cousin VL, Giraud R, Assouline B, Silva IN, Bendjelid K. Use of Carboxyhemoglobin as an Early Sign of Oxygenator Dysfunction in Patients Supported by Extracorporeal Membrane Oxygenation. Front Med (Lausanne) 2022; 9:893642. [PMID: 35572967 PMCID: PMC9106404 DOI: 10.3389/fmed.2022.893642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Plasma 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. Methods Retrospective 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. Results The 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). Conclusion Our data highlight the potential role of HbCO as a novel marker for ECMO oxygenator dysfunction.
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Affiliation(s)
- Vladimir L. Cousin
- Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland
- Geneva Hemodynamic Research Group, Geneva University, Geneva, Switzerland
- *Correspondence: Vladimir L. Cousin,
| | - Raphaël Giraud
- Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland
- Geneva Hemodynamic Research Group, Geneva University, Geneva, Switzerland
| | - Benjamin Assouline
- Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland
- Geneva Hemodynamic Research Group, Geneva University, Geneva, Switzerland
| | - Ivo Neto Silva
- Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland
- Geneva Hemodynamic Research Group, Geneva University, Geneva, Switzerland
| | - Karim Bendjelid
- Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland
- Geneva Hemodynamic Research Group, Geneva University, Geneva, Switzerland
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