BILIRUBIN ALBUMIN BINDING PARAMETERS IN SHEEP DURING EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Abstract

Three sheep (average wt. 32 kg) were anesthetized, ventilated and cannulated for venoarterial (VA-ECMO) by-pass procedure (Trans Am Soc Artif Intern Organ 28:350, 1982). Bilirubin albumin binding parameters were determined using a Bilirubin Hematoflurometer (Pediatr Res 17:127A, 1983). Pre-VA ECMO values were: hemoglobin (Hgb) 8-10 gm/dl; plasma Hgb 1-7mg/dl; Fibrinogen (F) 110-245 mg/dl; Fibrin split products (FSP) 10 μg/ml and platelet count (Plt) 495-880×103/mm3. During VA-ECMO, F was 96-225 mg/dl, FSP over 40 μg/ml and the Plt was 94-269×103/mm3. As shown (Figure), the Hgb and bilirubin levels varied, with elevation of plasma Hgb. In spite of hemoglobinemia suggesting intravascular hemolysis, the reserve bilirubin binding capacity (RBBC) and saturation index (SI) values were normal during the study. The normal RBBC and SI values would make the development of bilirubin neurotoxicity unlikely during VAECMO.