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Carboxyhemoglobin predicts oxygenator performance and imminent oxygenator change in extracorporeal membrane oxygenation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年4月24日

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  • Rolf Erlebach,
  • Alix Buhlmann,
  • Rea Andermatt,
  • Benjamin Seeliger,
  • Klaus Stahl,
  • Christian Bode,
  • Reto Schuepbach,
  • Pedro David Wendel-Garcia,
  • Sascha David,
  • Eva-Maria Kleinert,
  • Daniel Andrea Hofmaenner,
  • Mattia M Müller,
  • Christoph Camille Ganter,
  • Tobias Welte,
  • Thorben Pape,
  • Ann-Kathrin Rath,
  • Bahar Nalbant,
  • Jannik Ruwisch,
  • Christian Putensen,
  • Konrad Peukert,
  • Andrea Sauer,
  • Lennart Wild

摘要

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.