Risk Factors for Hemolysis During Extracorporeal Life Support for Congenital Diaphragmatic Hernia

Area of Science:

• Neonatal intensive care
• Pediatric surgery
• Extracorporeal membrane oxygenation

Background:

• Neonates with congenital diaphragmatic hernia (CDH) often require prolonged extracorporeal life support (ECLS).
• Hemolysis, a complication of ECLS, can lead to renal failure and adverse outcomes in these vulnerable patients.
• Identifying risk factors for hemolysis is crucial for improving management strategies.

Purpose of the Study:

• To identify risk factors associated with the development of hemolysis in neonates with CDH undergoing ECLS.
• To analyze demographic, pre-ECLS, and on-ECLS factors that may predict hemolysis.
• To inform clinical practice and potentially mitigate hemolysis complications.

Main Methods:

• Utilized the Extracorporeal Life Support Organization database (2000-2015) for infants diagnosed with CDH.
• Defined the primary outcome as hemolysis, indicated by plasma-free hemoglobin >50 mg/dL.
• Employed multivariable logistic regression models to assess associations between potential risk factors and hemolysis.

Main Results:

• A significant increase in hemolysis rates was observed with the use of centrifugal pumps compared to roller pumps over time.
• Centrifugal pumps were identified as a strong predictor of hemolysis (OR: 6.67, 95% CI: 5.14-8.67).
• Additional risk factors included low 5-min Apgar scores, on-ECLS complications (renal, metabolic, cardiovascular), and longer ECLS duration.

Conclusions:

• The study highlights an increasing trend of hemolysis in CDH patients on ECLS, correlating with the adoption of centrifugal pumps.
• Patient- and treatment-specific factors significantly contribute to the incidence of hemolysis.
• These findings underscore the need for vigilant monitoring and potential adjustments in ECLS management for CDH neonates.