• Catherine Gretchen, Hϋlya Bayir, Patrick M Kochanek, Kristine Ruppert, Melita Viegas, David Palmer, and Nahmah Kim-Campbell.
• Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
• Pediatr Crit Care Me. 2022 Feb 1; 23 (2): e111e119e111-e119.

ObjectivesTo determine potential risk factors for severe hemolysis during pediatric cardiopulmonary bypass and examine whether supraphysiologic levels of oxygen and cardiopulmonary bypass duration are associated with hemolysis.DesignProspective observational study.SettingCardiac ICU in a university-affiliated children's hospital.PatientsGreater than 1 month to less than 18 years old patients undergoing cardiopulmonary bypass for cardiac surgery.InterventionsNone.Measurements And Main ResultsPlasma samples from 100 patients to assess cell-free plasma hemoglobin levels were obtained at start cardiopulmonary bypass, at the end of cardiopulmonary bypass, and 2 and 24 hours after reperfusion. Arterial blood gas samples were obtained before and every 30 minutes during cardiopulmonary bypass. Patient demographics and laboratory data were collected from the electronic medical record. Plasma hemoglobin levels peaked at the end of cardiopulmonary bypass and haptoglobin levels continued to fall throughout all time points. There were 44 patients with severe hemolysis (change in cell-free plasma hemoglobin > 50 mg/dL). Younger age (odds ratio/sd 0.45 [95% CI, 0.25-0.81]) and higher mean Pao2 × cardiopulmonary bypass duration (31.11 [1.46-664.64]) were identified as risk factors for severe hemolysis in multivariable analysis. Severe hemolysis was associated with longer hospital and ICU lengths of stay as well as acute kidney injury.ConclusionsWe observed younger age and the exposure to both oxygen and duration of cardiopulmonary bypass as risk factors for hemolysis. Oxygen delivery through the cardiopulmonary bypass circuit is an easily modifiable risk factor. Its role in the production of reactive oxygen species that could alter the erythrocyte membrane deserves further examination in larger prospective studies.Copyright © 2021 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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