Patient-specific Predictors of Haemolysis with Percutaneous Ventricular Assist Devices.

Abstract

Introduction: Percutaneous ventricular assist devices (pVADs) are increasingly used in cardiogenic shock but are associated with complications including haemolysis. The aim of this study was to investigate patient characteristics associated with haemolysis in cardiogenic shock patient population.

Methods: Consecutive patients were identified using Current Procedural Terminology (CPT) codes for pVAD insertion. Patient characteristics, laboratory and imaging data, and patient outcomes were abstracted manually and using validated automated methods. Laboratory-defined haemolysis required a drop in haemoglobin ≥2 mg/dl with either lactate dehydrogenase ≥250 units/l or undetectable haptoglobin. Clinically significant haemolysis was defined as laboratory-defined haemolysis necessitating transfusion. Primary outcome was the association between haemolysis and on-device and 30-day mortality.

Results: A total of 196 patients underwent pVAD insertion for cardiogenic shock during the study period and were included. Laboratory-defined haemolysis occurred in 46 patients (23.5%), of whom 12 (6.1%) had clinically significant haemolysis. Haemolysis occurred more often following emergency insertion, rather than elective insertion (84.8% versus 40.0%, p<0.001) in patients with elevated lactic acid levels (median 2.5 versus 1.6, p=0.016) and elevated heart rates (92.5 BPM versus 86.5 BPM, p=0.023). After multivariable adjustment, there was no association between laboratory-defined haemolysis and on-device (OR 0.6; 95% CI [0.1-3.4]; p=0.565) or 30-day mortality (OR 2.1; 95% CI [0.4-13.0]; p=0.391).

Conclusion: Laboratory-defined haemolysis was common in patients with cardiogenic shock and pVAD, but clinically significant haemolysis was not. There was no association between haemolysis and on-device or 30-day mortality.