Extracorporeal membrane oxygenation combined with continuous renal replacement therapy for the treatment of severe burns: current status and challenges

Abstract

Severe burns often cause various systemic complications and multiple organ dysfunction syndrome, which is the main cause of death. The lungs and kidneys are vulnerable organs in patients with multiple organ dysfunction syndrome after burns. Extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) have been gradually applied in clinical practice and are beneficial for severe burn patients with refractory respiratory failure or renal dysfunction. However, the literature on ECMO combined with CRRT for the treatment of severe burns is limited. Here, we focus on the current status of ECMO combined with CRRT for the treatment of severe burns and the associated challenges, including the timing of treatment, nutrition support, heparinization and wound management, catheter-related infection and drug dosing in CRRT. With the advancement of medical technology, ECMO combined with CRRT will be further optimized to improve the outcomes of patients with severe burns.

Efficacy and safety of extracorporeal membrane oxygenation for burn patients: a comprehensive systematic review and meta-analysis

“…A multicenter international survey showed that the indications for starting CRRT on ECMO were fluid overload treatment (43%), fluid overload prevention (16%), acute kidney injury (35%) and electrolyte imbalance (4%) [ 52 , 53 ]. However, the detailed indications, timing, anticoagulation strategy, infection, nutrition support and wound management varied between studies and need further optimization for burn patients [ 54 ].…”

Veno-venous extracorporeal membrane oxygenation, cytokine removal and continuous renal replacement therapy in a severe burn adult patient

“…Randomized control trials of ECMO versus conventional therapy in severe ARDS following severe burn injuries will probably address the problem in the future but the limit remains the low number of patients recruitable. Since renal failure is associated with negative outcome in burn patients 7,18 and multiple organ failure due to sepsis is reported as a major cause of mortality in recurrent studies, the use of hemofiltration combined with hemoadsorption may prove to have beneficial effects on outcome. Cytokine reduction during CRRT in the setting of inflammatory response associated ARDS is reported to result in rapid and significant reduction in the levels of IL-6 and IL-8, improvement in hemodynamic stability, increase in P/F ratio and diminution of capillary leak syndrome.…”

A case report of gadopentetate dimeglumine‐induced cardiac arrest: Resuscitation using extracorporeal membrane oxygenation

“…In addition, CRRT was implemented in a patient who was diagnosed with an acute kidney injury (AKI) to correct metabolic disturbances and control volume (Karkar & Ronco, 2020). In addition, CRRT may decrease internal contrast media levels, thereby alleviating allergic reactions (Song et al, 2021).…”