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Updated: Feb 23, 2026
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Incidence, Risk Factors, and Outcomes of Hyperbilirubinemia in Adult Cardiac Patients Supported by Veno-Arterial ECMO
Lin Lyu1, Jingxin Yao1, Guodong Gao1
1Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Insights
Hyperbilirubinemia is common in cardiac patients on VA ECMO, affecting 73%. High bilirubin levels correlate with low platelets and increased in-hospital mortality, indicating risk factors like hemolysis and liver dysfunction.
Area of Science:
- Cardiology
- Hepatology
- Critical Care Medicine
Background:
- Hyperbilirubinemia is a potential complication in patients requiring veno-arterial extracorporeal membrane oxygenation (VA ECMO).
- Understanding the incidence, risk factors, and outcomes of hyperbilirubinemia in this population is crucial for improving patient management.
Purpose of the Study:
- To evaluate the incidence, risk factors, and outcomes of hyperbilirubinemia in adult cardiac patients undergoing VA ECMO.
- To identify key laboratory parameters and clinical factors associated with elevated total bilirubin levels during VA ECMO support.
Main Methods:
- Retrospective review of data from 89 adult cardiac patients who received VA ECMO.
- Patients were categorized into normal, high, and severe high bilirubin groups based on total bilirubin levels.
- Multiple linear regression and repeated measures ANOVA were used to analyze associations between bilirubin levels and other variables.
Main Results:
- The incidence of hyperbilirubinemia (total bilirubin >3 mg/dL) was 73% among patients on VA ECMO.
- Elevated peak total bilirubin was significantly associated with peak AST, peak pFHb, and baseline total bilirubin.
- Patients with severe hyperbilirubinemia exhibited lower platelet counts and a reduced in-hospital survival rate.
Conclusions:
- Hyperbilirubinemia is a frequent occurrence in cardiac patients supported by VA ECMO.
- Risk factors for hyperbilirubinemia include hemolysis, liver dysfunction during ECMO, and pre-existing high bilirubin levels.
- Hyperbilirubinemia is linked to adverse outcomes, including thrombocytopenia and increased in-hospital mortality, underscoring the need for vigilant monitoring and management.
Abstract:
The aims of this study were to evaluate the incidence, risk factors, and outcomes of hyperbilirubinemia in cardiac patients with veno-arterial (VA) ECMO. Data on 89 adult patients with cardiac diseases who received VA ECMO implantation in our hospital were retrospectively reviewed. All patients were divided into the following three groups: 24 in normal group (N, total bilirubin [TBIL] ≤3 mg/dL), 30 in high bilirubin group (HB, 6 mg/dL ≥ TBIL > 3 mg/dL), and 35 in severe high bilirubin group (SHB, TBIL > 6 mg/dL). lg(variables + 1) was performed for nonnormally distributed variables. The incidence of hyperbilirubinemia (>3 mg/dL) was 73%. In a multiple linear regression analysis, lg(peak TBIL + 1) was significantly associated with lg(peak AST + 1) (b-coefficient 0.188, P = 0.001), lg(peak pFHb + 1) (b-coefficient 0.201, P = 0.003), and basic TBIL (b-coefficient 0.006, P = 0.009). Repeated measurement analysis of variance revealed that the main effect for three groups in pFHb and lg(AST + 1) was significant at first 3 days during ECMO. The patients in SHB had low platelets during ECMO and low in-hospital survival rate. Hyperbilirubinemia remains common in patients with VA ECMO and is associated with low platelets and high in-hospital mortality. Hemolysis and liver dysfunction during ECMO and basic high bilirubin levels are risk factors of hyperbilirubinemia.
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