Journal Article Epublish 3 citations
PubMed: 37614802 DOI: 10.1097/CCE.0000000000000957
U-Shaped Association Between Carboxyhemoglobin and Mortality in Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation.
Crit Care Explor 5(8):e0957
Authors: Amber Meservey, Govind Krishnan, Cynthia L Green, Samantha Morrison, Craig R Rackley, Bryan D Kraft
Affiliations
- Department of Medicine, Duke University School of Medicine, Durham, NC.
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC.
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Abstract
Background
Carbon monoxide (CO) is an endogenous signaling molecule that activates cytoprotective programs implicated in the resolution of acute respiratory distress syndrome (ARDS) and survival of critical illness. Because CO levels can be measured in blood as carboxyhemoglobin, we hypothesized that carboxyhemoglobin percent (COHb%) may associate with mortality.
OBJECTIVES
To examine the relationship between COHb% and outcomes in patients with ARDS requiring venovenous extracorporeal membrane oxygenation (ECMO), a condition where elevated COHb% is commonly observed.
DESIGN
Retrospective cohort study.
SETTING
Academic medical center ICU.
PATIENTS
Patients were included that had ARDS on venovenous ECMO.
MEASUREMENTS AND MAIN RESULTS
We examined the association between COHb% and mortality using a Cox proportional hazards model. Secondary outcomes including ECMO duration, ventilator weaning, and hospital and ICU length of stay were examined using both subdistribution and causal-specific hazard models for competing risks. We identified 109 consecutive patients for analysis. Mortality significantly decreased per 1 U increase in COHb% below 3.25% (hazard ratio [HR], 0.35; 95% CI, 0.15-0.80; = 0.013) and increased per 1 U increase above 3.25% (HR, 4.7; 95% CI, 1.5-14.7; = 0.007) reflecting a nonlinear association ( = 0.006). Each unit increase in COHb% was associated with reduced likelihood of liberation from ECMO and mechanical ventilation, and increased time to hospital and ICU discharge (all < 0.05). COHb% was significantly associated with hemolysis but not with initiation of hemodialysis or blood transfusions.
CONCLUSIONS
In patients with ARDS on venovenous ECMO, COHb% is a novel biomarker for mortality exhibiting a U-shaped pattern. Our findings suggest that too little CO (perhaps due to impaired host signaling) or excess CO (perhaps due to hemolysis) is associated with higher mortality. Patients with low COHb% may exhibit the most benefit from future therapies targeting anti-oxidant and anti-inflammatory pathways such as low-dose inhaled CO gas.
MeSH
Mortality, Antioxidants, Extracorporeal Membrane Oxygenation, Membranes, Intensive Care Units, Hemolysis, Blood, Respiratory Distress Syndrome, Carboxyhemoglobin