Hemolysis Monitoring Practices during Extracorporeal Membrane Oxygenation: A Survey Report

Introduction: Intravascular hemolysis is a significant complication of extracorporeal membrane oxygenation (ECMO), associated with adverse outcomes such as kidney failure and increased mortality. There is wide variability in the cited incidence of this complication. This survey study aimed to characterize the variability in hemolysis monitoring practices across ECMO centers. Methods: The survey, distributed via the Extracorporeal Life Support Organization (ELSO) newsletter, received 26 responses from various healthcare professionals, including nurses, perfusionists, respiratory therapists, and physicians. Respondents represented both pediatric and adult ECMO units, primarily from academic centers in the USA (46%). Results: Findings revealed that 92% of these centers use centrifugal pumps, with heparin and bivalirudin being the preferred anticoagulants. While 68% of respondents reported having a standard protocol for hemolysis monitoring, the specific protocols varied widely. Plasma-free hemoglobin was the most commonly monitored laboratory test. Definitions for what were considered significant hemolysis varied as well and were primarily identified by red urine and elevated plasma hemoglobin levels. Interventions to address hemolysis included adjusting pump speed, repositioning cannulas, replacing pump heads or oxygenators, and performing plasmapheresis. Conclusion: The study highlights the variability in hemolysis monitoring practices among ECMO centers. Further research is warranted to establish optimal monitoring protocols to detect and potentially treat the complication of hemolysis.