Continuous renal replacement therapy in patients treated with extracorporeal membrane oxygenation

Selewski, David T.; Wille, Keith

doi:10.1111/sdi.12965

Cited by 33 publications

(20 citation statements)

References 106 publications

(98 reference statements)

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“…The incidence of acute kidney injury in patients supported by ECMO could be as high as 75%, and increased mortality has been reported in multiple retrospective cohort studies. [11][12][13] In terms of renal complications, the pathophysiology of acute kidney injury in those supported on ECMO could be related to multiple etiologies. 11 These include pre-cannulation issues such as cardio-renal syndrome, severity of illness, hypotension requiring vasopressor support, cardiac arrest, or nephrotoxin exposure.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13] In terms of renal complications, the pathophysiology of acute kidney injury in those supported on ECMO could be related to multiple etiologies. 11 These include pre-cannulation issues such as cardio-renal syndrome, severity of illness, hypotension requiring vasopressor support, cardiac arrest, or nephrotoxin exposure. In addition, we should consider post-cannulation issues such as hemolysis, coagulation abnormalities, or inflammatory cytokines.…”

Section: Discussionmentioning

confidence: 99%

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The use of veno-arterial extracorporeal membrane oxygenation in the octogenarian population: A single-center experience

et al. 2022

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Introduction Advanced age is a known risk factor for poor outcomes after veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for cardiac support. The use of ECMO support in patients over the age of 80 is controversial, and sometimes its use is contraindicated. We aimed to assess the use of ECMO in octogenarian patients to determine survival and complication rates. Methods A single-center, retrospective analysis was completed at a large, urban academic medical center. Patients requiring V-A ECMO support between December of 2012 and November of 2019 were included as long as the patient was at least 80 years of age at the time of cannulation. Post cardiotomy shock patients were excluded. Results A total of 46 patients met eligibility criteria; all received V-A ECMO support. Overall, the majority of patients (71.7%; 33/46) survived to decannulation, and 43.5% (20/46) survived to discharge. Patients who were previously rescued from percutaneous interventions tend to have a better survival than other patients ( p = .06). The most common complications were renal and hemorrhagic. Conclusions We demonstrated that advanced age alone should not disqualify patients from cannulating and supporting with V-A ECMO.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The use of veno-arterial extracorporeal membrane oxygenation in the octogenarian population: A single-center experience

et al. 2022

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“…For LVAD system, the current guidelines recommend the combination of anticoagulant therapy (warfarin) with antiplatelet therapy (aspirin) for the prevention of thrombosis and device failure [65]. ICU patients undergoing ECMO often develop severe AKI requiring RRT [66]. In the presence of two extracorporeal circuits (CRRT and ECMO), the contact of the blood with multiple non-biological surfaces may enhance the activation of the coagulation cascade; thus, an adequate anticoagulation strategy is required in this specific setting.…”

Section: Rationalementioning

confidence: 99%

Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission

Pistolesi

Morabito²,

Pota³

et al. 2023

J Anesth Analg Crit Care

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Renal replacement therapies (RRT) are essential to support critically ill patients with severe acute kidney injury (AKI), providing control of solutes, fluid balance and acid–base status. To maintain the patency of the extracorporeal circuit, minimizing downtime periods and blood losses due to filter clotting, an effective anticoagulation strategy is required.Regional citrate anticoagulation (RCA) has been introduced in clinical practice for continuous RRT (CRRT) in the early 1990s and has had a progressively wider acceptance in parallel to the development of simplified systems and safe protocols. Main guidelines on AKI support the use of RCA as the first line anticoagulation strategy during CRRT in patients without contraindications to citrate and regardless of the patient’s bleeding risk.Experts from the SIAARTI-SIN joint commission have prepared this position statement which discusses the use of RCA in different RRT modalities also in combination with other extracorporeal organ support systems. Furthermore, advise is provided on potential limitations to the use of RCA in high-risk patients with particular attention to the need for a rigorous monitoring in complex clinical settings. Finally, the main findings about the prospective of optimization of RRT solutions aimed at preventing electrolyte derangements during RCA are discussed in detail.

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“…The treatment and prevention of fluid overload and AKI in ECMO patients is typically managed using renal replacement therapy (RRT). Studies show that between 20 and 100% of ECMO patients suffering from AKI are treated with RRT before or during the ECMO treatment ( 11 , 51 , 52 ). CRRT is the most common modality used in the treatment of ECMO patients.…”

Section: Medical Backgroundmentioning

confidence: 99%

Trends, Advantages and Disadvantages in Combined Extracorporeal Lung and Kidney Support From a Technical Point of View

Costa

Halfwerk

Wiegmann

et al. 2022

Front. Med. Technol.

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Extracorporeal membrane oxygenation (ECMO) provides pulmonary and/or cardiac support for critically ill patients. Due to their diseases, they are at high risk of developing acute kidney injury. In that case, continuous renal replacement therapy (CRRT) is applied to provide renal support and fluid management. The ECMO and CRRT circuits can be combined by an integrated or parallel approach. So far, all methods used for combined extracorporeal lung and kidney support present serious drawbacks. This includes not only high risks of circuit related complications such as bleeding, thrombus formation, and hemolysis, but also increase in technical workload and health care costs. In this sense, the development of a novel optimized artificial lung device with integrated renal support could offer important treatment benefits. Therefore, we conducted a review to provide technical background on existing techniques for extracorporeal lung and kidney support and give insight on important aspects to be addressed in the development of this novel highly integrated artificial lung device.

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Continuous renal replacement therapy in patients treated with extracorporeal membrane oxygenation

Cited by 33 publications

References 106 publications

The use of veno-arterial extracorporeal membrane oxygenation in the octogenarian population: A single-center experience

The use of veno-arterial extracorporeal membrane oxygenation in the octogenarian population: A single-center experience

Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission

Trends, Advantages and Disadvantages in Combined Extracorporeal Lung and Kidney Support From a Technical Point of View

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