Troubleshooting: Hemolysis:
Hemolysis occurs in almost every ECMO patient to a certain degree. Hemolysis may be manifested by the following:
- Anemia.
- Increased bilirubin, LDH, and free Hb.
- Pigment nephropathy: dark urine, or high potassium in CRRT effluent if patient is on dialysis.
The main cause of hemolysis is mechanical destruction of red blood cells passing through the pump, and can be explained by:
- Relatively high pump speeds.
- Malposition of the drainage cannula causing a "suck down" effect in the IVC or SVC.
- Thrombosis of the centrifugal pump.
If the patient is having ongoing hemolysis then:
- Transfuse red blood cells as necessary to maintain an appropriate hemoglobin level.
- A trial of reduced pump speed may be warranted.
- Repositioning of the drainage cannula may be necessary if a "suck down" effect is seen.
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