Cargando…
Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry
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...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9324470/ https://www.ncbi.nlm.nih.gov/pubmed/35885547 http://dx.doi.org/10.3390/diagnostics12071642 |
_version_ | 1784756814886207488 |
---|---|
author | Bemtgen, Xavier Rilinger, Jonathan Holst, Manuel Rottmann, Felix Lang, Corinna N. Jäckel, Markus Zotzmann, Viviane Benk, Christoph Wengenmayer, Tobias Supady, Alexander Staudacher, Dawid L. |
author_facet | Bemtgen, Xavier Rilinger, Jonathan Holst, Manuel Rottmann, Felix Lang, Corinna N. Jäckel, Markus Zotzmann, Viviane Benk, Christoph Wengenmayer, Tobias Supady, Alexander Staudacher, Dawid L. |
author_sort | Bemtgen, Xavier |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9324470 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-93244702022-07-27 Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry Bemtgen, Xavier Rilinger, Jonathan Holst, Manuel Rottmann, Felix Lang, Corinna N. Jäckel, Markus Zotzmann, Viviane Benk, Christoph Wengenmayer, Tobias Supady, Alexander Staudacher, Dawid L. Diagnostics (Basel) Article 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. MDPI 2022-07-05 /pmc/articles/PMC9324470/ /pubmed/35885547 http://dx.doi.org/10.3390/diagnostics12071642 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Bemtgen, Xavier Rilinger, Jonathan Holst, Manuel Rottmann, Felix Lang, Corinna N. Jäckel, Markus Zotzmann, Viviane Benk, Christoph Wengenmayer, Tobias Supady, Alexander Staudacher, Dawid L. Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry |
title | Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry |
title_full | Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry |
title_fullStr | Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry |
title_full_unstemmed | Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry |
title_short | Carboxyhemoglobin (CO-Hb) Correlates with Hemolysis and Hospital Mortality in Extracorporeal Membrane Oxygenation: A Retrospective Registry |
title_sort | carboxyhemoglobin (co-hb) correlates with hemolysis and hospital mortality in extracorporeal membrane oxygenation: a retrospective registry |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9324470/ https://www.ncbi.nlm.nih.gov/pubmed/35885547 http://dx.doi.org/10.3390/diagnostics12071642 |
work_keys_str_mv | AT bemtgenxavier carboxyhemoglobincohbcorrelateswithhemolysisandhospitalmortalityinextracorporealmembraneoxygenationaretrospectiveregistry AT rilingerjonathan carboxyhemoglobincohbcorrelateswithhemolysisandhospitalmortalityinextracorporealmembraneoxygenationaretrospectiveregistry AT holstmanuel carboxyhemoglobincohbcorrelateswithhemolysisandhospitalmortalityinextracorporealmembraneoxygenationaretrospectiveregistry AT rottmannfelix carboxyhemoglobincohbcorrelateswithhemolysisandhospitalmortalityinextracorporealmembraneoxygenationaretrospectiveregistry AT langcorinnan carboxyhemoglobincohbcorrelateswithhemolysisandhospitalmortalityinextracorporealmembraneoxygenationaretrospectiveregistry AT jackelmarkus carboxyhemoglobincohbcorrelateswithhemolysisandhospitalmortalityinextracorporealmembraneoxygenationaretrospectiveregistry AT zotzmannviviane carboxyhemoglobincohbcorrelateswithhemolysisandhospitalmortalityinextracorporealmembraneoxygenationaretrospectiveregistry AT benkchristoph carboxyhemoglobincohbcorrelateswithhemolysisandhospitalmortalityinextracorporealmembraneoxygenationaretrospectiveregistry AT wengenmayertobias carboxyhemoglobincohbcorrelateswithhemolysisandhospitalmortalityinextracorporealmembraneoxygenationaretrospectiveregistry AT supadyalexander carboxyhemoglobincohbcorrelateswithhemolysisandhospitalmortalityinextracorporealmembraneoxygenationaretrospectiveregistry AT staudacherdawidl carboxyhemoglobincohbcorrelateswithhemolysisandhospitalmortalityinextracorporealmembraneoxygenationaretrospectiveregistry |