Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy*

Selewski, David T.; Cornell, Timothy T.; Blatt, Neal B.; Han, Yong; Mottes, Theresa; Kommareddi, Mallika; Gaies, Michael; Annich, Gail M.; Kershaw, David B.; Shanley, Thomas P.; Heung, Michael

doi:10.1097/ccm.0b013e318258ff01

Cited by 171 publications

(148 citation statements)

References 26 publications

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“…Future work should aim to determine a mechanism for this finding. Fluid overload is associated with mortality in pediatric patients requiring CRRT [23][24][25][26][27] ; however, no study to date has demonstrated causality. Selewski et al 27 demonstrated in We did not consider hospital LOS, post-ECLS-days, or total mechanical ventilation-days in the multiple regression models, as these are in the direct pathway from exposure to outcome.…”

Section: Discussionmentioning

confidence: 99%

Survival and Neurocognitive Outcomes After Cardiac Extracorporeal Life Support in Children Less Than 5 Years of Age

Ryerson

Guerra

Joffe

et al. 2015

Circ: Heart Failure

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Background— Survival after pediatric cardiac extracorporeal life support (ECLS) is guarded, and neurological morbidity varies widely. Our objective is to report our 10-year experience with cardiac ECLS, including survival and kindergarten entry neurocognitive outcomes; to identify predictors of mortality or adverse neurocognitive outcomes; and to compare 2 eras, before and after 2005. Methods and Results— From 2000 to 2009, 98 children had venoarterial cardiac ECLS. Sixty-four patients (65%) survived to hospital discharge, and 50 (51%) survived ≤5 years of age. Neurocognitive follow-up of survivors was completed at mean (SD) age of 52.9 (8) months using Wechsler Preschool and Primary Scale of Intelligence. Logistic regression analysis found the longer time (hours) for lactate to fall below 2 mmol/L on ECLS (hazard ratio, 1.39; 95% confidence interval, 1.05, 1.84; P =0.022), and the amount of platelets (mL/kg) given in the first 48 hours (hazard ratio, 1.18; 95% confidence interval, 1.06, 1.32; P =0.002) was independently associated with higher in-hospital mortality. Receiving ECLS after the year 2005 was independently associated with lower risk of in-hospital mortality (hazard ratio, 0.36; 95% confidence interval, 0.13, 0.99; P =0.048). Extracorporeal cardiopulmonary resuscitation was not independently associated with mortality or neurocognitive outcomes. Era was not independently associated with neurocognitive outcomes. The full-scale intelligence quotient of survivors without chromosomal abnormalities was 79.7 (16.6) with 25% below 2 SD of the population mean. Conclusions— Mortality has improved over time; time for lactate to fall on ECLS and volume of platelets transfused are independent predictors of mortality. Extracorporeal cardiopulmonary resuscitation and era were not independently associated with neurocognitive outcomes.

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Section: Discussionmentioning

confidence: 99%

Survival and Neurocognitive Outcomes After Cardiac Extracorporeal Life Support in Children Less Than 5 Years of Age

Ryerson

Guerra

Joffe

et al. 2015

Circ: Heart Failure

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“…Other investigators have suggested the importance of initiating CRRT during ECMO in patients in the early phases of renal dysfunction with fluid overload or inflammation [23]. In addition, Selewski et al [24] reported that initiating CRRT before the development of a significant fluid overload may be more clinically effective than attempting fluid removal after the fluid overload has developed. Thus, the lack of a survival benefit with early dialysis in our study may be an indicator of the fact that CRRT had not been initiated early enough in our ECMO patients.…”

Section: Discussionmentioning

confidence: 99%

Early Continuous Renal Replacement Therapy in Cardiogenic Shock Patients with Severe Acute Kidney Injury Undergoing Extracorporeal Membrane Oxygenation

Lin¹,

Lin²,

Lin

et al. 2014

Cardiorenal Med

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Background: Continuous renal replacement therapy (CRRT) may benefit patients requiring extracorporeal membrane oxygenation (ECMO). However, the clinical benefits and timing of CRRT have not been fully elucidated for these patients. Methods: This study was conducted retrospectively at the Taipei Medical University Hospital between January 2008 and December 2010. We included patients who had Acute Kidney Injury Network (AKIN) stage 3 disease at the initiation of ECMO and subsequently underwent CRRT. We excluded patients aged <18 years or those who were chronic dialysis patients. Early dialysis was defined as receiving CRRT <24 h after the initiation of ECMO. The primary outcome was mortality before weaning from ECMO. Results: The median age of the 15 patients included in the study was 72 years. The median interval between ECMO and CRRT was 16 h. No significant difference in survival was observed between the early- and late-dialysis patients (p = 0.58, log-rank test). However, a trend toward a shorter mean duration of ECMO therapy was observed in the early-dialysis patients (124 vs. 169 h, p = 0.16). The median follow-up glomerular filtration rate for the survivors was 38.9 ml/min/1.73 m². Conclusion: No survival benefit is conferred by the use of CRRT within 24 h after initiating ECMO in patients with severe acute kidney injury according to AKIN criteria. © 2014 S. Karger AG, Basel

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“…Many studies have shown that the application of ECMO may cause deterioration in renal functions and acute renal injuries that can lead to increase in mortality rates (23)(24)(25). Nephrotoxic agents used in the patients treated with ECMO lead to decreased renal perfusion during ECMO support and infections, blood transfusions, systemic inflammatory reaction syndrome and hemolysis may be associated with renal damage.…”

Section: Discussionmentioning

confidence: 99%

Utilization of Extracorporeal Membrane Oxygenation In Pediatric Cardiac Surgery: A Single Center Experience, 34 Cases in 8 Years

Zeybek

Avsar

Yildirim³

et al. 2017

Iran J Pediatr

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Background: Extracorporeal membrane oxygenation (ECMO) is used in a variety of indications worldwide. One of the most important subsets is postoperative congenital cardiac surgery cases unresponsive to conventional therapies. In this study, we present our ECMO experience in a single congenital cardiac surgery center. Methods: ECMO was used in a total of 34 postoperative congenital cardiac surgery cases, whose operations had been performed by the same congenital cardiac surgery team. Patients' ages were between 3 days to 15 years. ECMO was used in four different indications; in case of unsuccessful weaning from cardiopulmonary bypass (OR-ECMO), in low cardiac output syndrome (LCOS-ECMO), in refractory post cardiac arrest (CPR-ECMO) and in respiratory insufficiency after RSV infection (RSV-ECMO). Results: The follow-up period of patients ranged from 1 to 80 months, whereas ECMO duration ranged from 23 to 2218 hours. Six cases were OR-ECMO, 13 were LCOS-ECMO, 12 were CPR-ECMO and 3 were RSV-ECMO. Out of a total of 34 cases, 20 (58%) cases were weaned from ECMO. Two of the patients, who were able to be weaned from ECMO passed away in the hospital; however, the other 18 patients (52.9%) were discharged from the hospital without having any significant neurological deficits. The top survival rate (69%) and weaning from ECMO was in the LCOS-ECMO group and the worst weaning from ECMO support (33%) was in the RSV-ECMO. The worst survival rate (25%) was in the CPR-ECMO group. Sepsis and associated multiple organ dysfunction were observed as the major cause of mortality in these patients. The most common complications were bleeding and mechanical complications related to cannulation. Conclusions: ECMO may be required in postoperative congenital cardiac surgery cases in whom all other conventional therapies have failed. Indications, timing and maintenance of equipment are very important points in successful ECMO management. Increasing ECMO experience in the near future, will provide much decrease in mortality of congenital cardiac surgery.

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Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy*

Cited by 171 publications

References 26 publications

Survival and Neurocognitive Outcomes After Cardiac Extracorporeal Life Support in Children Less Than 5 Years of Age

Survival and Neurocognitive Outcomes After Cardiac Extracorporeal Life Support in Children Less Than 5 Years of Age

Early Continuous Renal Replacement Therapy in Cardiogenic Shock Patients with Severe Acute Kidney Injury Undergoing Extracorporeal Membrane Oxygenation

Utilization of Extracorporeal Membrane Oxygenation In Pediatric Cardiac Surgery: A Single Center Experience, 34 Cases in 8 Years

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