Continuous Renal Replacement Therapy With an Automated Monitor Is Superior to a Free-Flow System During Extracorporeal Life Support*

Symons, Jordan M.; McMahon, Marcus Wayne; Karamlou, Tara; Parrish, Andrea Rae; McMullan, D. Michael

doi:10.1097/pcc.0b013e31829f5c09

Cited by 30 publications

(20 citation statements)

References 12 publications

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“…Thirty-one citations were obtained in full text and 12 of these were excluded: four investigated patients who underwent ECMO plus CRRT, but without comparison, one with ECMO plus intermittent RRT, two with duplicate publication, one with commentary, one cross-sectional survey, one with CRRT only, one with ECMO only and one review. In total, 19 studies were included, consisting of seven cohort studies [ 13 - 19 ], six case control studies [ 20 - 25 ], one historically controlled trial [ 26 ] and five studies of technical aspects [ 27 - 31 ]. Seventeen studies were published in English [ 13 - 23 , 26 ] and two in Chinese with English abstracts [ 24 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

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Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy in critically ill patients: a systematic review

et al. 2014

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IntroductionExtracorporeal membrane oxygenation (ECMO) is used in critically ill patients presenting acute cardiac and/or pulmonary dysfunctions, who are at high risk of developing acute kidney injury and fluid overload. Continuous renal replacement therapy (CRRT) is commonly used in intensive care units (ICU) to provide renal replacement and fluid management. We conducted a review to assess the feasibility, efficacy and safety of the combination of ECMO and CRRT and to illustrate the indications and methodology of providing renal replacement therapy during the ECMO procedure.MethodWe searched for all published reports of a randomized controlled trial (RCT), quasi-RCT, or other comparative study design, conducted in patients undergoing ECMO plus CRRT. Two reviewers independently selected potential studies and extracted data. We used the modified Jadad scale and the Newcastle-Ottawa for quality assessment of RCTs and non-RCTs, respectively. Statistical analyses were performed using RevMan 5.2.ResultsWe identified 19 studies meeting the eligibility criteria (seven cohort, six case control, one historically controlled trial and five studies of technical aspects). There are three major methods for performing CRRT during ECMO: ‘independent CRRT access’, ‘introduction of a hemofiltration filter into the ECMO circuit (in-line hemofilter)’ and ‘introduction of a CRRT device into the ECMO circuit’. We conducted a review with limited data synthesis rather than a formal meta-analysis because there could be greater heterogeneity in a systematic review of non-randomized studies than that of randomized trials. For ECMO survivors receiving CRRT, overall fluid balance was less than that in non-CRRT survivors. There was a higher mortality and a longer ECMO duration when CRRT was added, which may reflect a relatively higher severity of illness in patients who received ECMO plus CRRT.ConclusionsThe combination of ECMO and CRRT in a variety of methods appears to be a safe and effective technique that improves fluid balance and electrolyte disturbances. Prospective studies would be beneficial in determining the potential of this technique to improve the outcome in critically ill patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0675-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…Symons et al . reported that introduction of a CRRT device into the ECMO circuit provides more accurate fluid management during ECMO [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy in critically ill patients: a systematic review

et al. 2014

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“…Symons observó que estos pacientes tenían un manejo más preciso de fluidos 23 , lo cual concuerda con los hallazgos de Chen, quien reportó que los sobrevivientes post-ECMO en TRRC tenían un mejor balance de líquidos 15 . Durante la combinación de ECMO y TRRC, las alarmas de presión se pueden activar en las líneas de entrada y salida de la máquina de TRRC.…”

Section: A Través Del Acoplamiento De Una Máquina De Trrcunclassified

Terapia de reemplazo renal continua en el paciente con oxigenación por membrana extracorpórea: consideraciones para la combinación de ambas terapias

et al. 2018

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“…As suggested by the name, CRRT allows for slow and continual removal of solutes and fluid from the extracellular space, avoiding abrupt changes in extracellular space volume and solute concentrations, which may be poorly tolerated by critically ill neonates. Further, fluid management is very efficient during CRRT and can be more precisely controlled than with fluid restriction, peritoneal dialysis, or diuretic therapy, particularly when integrated systems are used . Diffusive clearance, convective clearance, or a combination of both can be provided by CRRT, depending upon the mode utilized.…”

Section: Complications and Concurrent Therapiesmentioning

confidence: 99%

“…Further, fluid management is very efficient during CRRT and can be more precisely controlled than with fluid restriction, peritoneal dialysis, or diuretic therapy, particularly when integrated systems are used. 37 Diffusive clearance, convective clearance, or a combination of both can be provided by CRRT, depending upon the mode utilized. The efficiency of diffusive and convective clearance is related to molecular size and weight of the given molecule as well as the magnitude of the concentration gradient.…”

Section: Complications and Concurrent Therapiesmentioning

confidence: 99%

Neonatal Extracorporeal Life Support: A Review of Nutrition Considerations

2018

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Critically ill neonates who require extracorporeal life support have particular nutrition needs. These infants require prescription of aggressive, early nutrition support by knowledge providers. Understanding the unique metabolic demands and nutrition requirements of these fragile patients is paramount, particularly if additional therapies such as aggressive diuretic regimens or continuous renal replacement therapy are used concurrently. Although the American Society for Parenteral and Enteral Nutrition has published guidelines for this population, a review of each nutrition component is warranted because few studies exist specific to this population. Long-term complications in survivors of neonatal extracorporeal life support, particularly in patients with select diagnoses such as congenital diaphragmatic hernia, can be significant and must be recognized and anticipated. This review focuses on recognizing the nutrition needs of neonatal patients requiring extracorporeal life support, appraising the available data to guide selection of an appropriate mode of nutrition delivery, and describing the anticipated long-term nutrition implications of extracorporeal life support provision during the neonatal period.

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Continuous Renal Replacement Therapy With an Automated Monitor Is Superior to a Free-Flow System During Extracorporeal Life Support*

Cited by 30 publications

References 12 publications

Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy in critically ill patients: a systematic review

Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy in critically ill patients: a systematic review

Terapia de reemplazo renal continua en el paciente con oxigenación por membrana extracorpórea: consideraciones para la combinación de ambas terapias

Neonatal Extracorporeal Life Support: A Review of Nutrition Considerations

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