Hemolysis Monitoring Practices during Extracorporeal Membrane Oxygenation: A Survey Report
Survey / observational published in Blood Purif (2025)
Abstract
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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Survey of 26 ECMO centers describing hemolysis-monitoring practices and confirming heparin and bivalirudin as the predominant anticoagulants. Documents wide variability in protocols, thresholds, and interventions.
Why This Matters for Hirudotherapy
This survey study characterized variability in hemolysis monitoring practices across ECMO centers, receiving 26 responses primarily from US academic centers. The abstract reports that heparin and bivalirudin—a direct thrombin inhibitor derived from hirudin—were the preferred anticoagulants, and that 68% of centers had standard hemolysis monitoring protocols that varied widely. For ASH, the relevance is indirect: bivalirudin is a pharmaceutical derivative of the leech anticoagulant hirudin, but the study focuses on ECMO hemolysis monitoring practices rather than leech therapy or the leech secretome per se. No conclusions about bivalirudin's efficacy or safety relative to heparin are drawn from this survey. The small sample (26 responses) limits representativeness.
Citation
Hemolysis Monitoring Practices during Extracorporeal Membrane Oxygenation: A Survey Report.
Strong AE et al. · Blood purification, 2025
Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026