Renal Replacement Therapy for Patients Requiring ECMO Support

2019 ◽  
pp. 121-135
Author(s):  
Anna Maslach-Hubbard ◽  
Raoul Nelson ◽  
Jamie Furlong-Dillard
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Ecmo Support

Single-center experience with intraoperative extracorporeal membrane oxygenation use in lung transplantation

2017 ◽  
Vol 41 (2) ◽  
pp. 89-93 ◽  
Author(s):  
Tugba Cosgun ◽  
Sandra Tomaszek ◽  
Isabelle Opitz ◽  
Markus Wilhelm ◽  
Macé M. Schuurmans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Replacement Therapy ◽  
Support Group ◽  
Ecmo Support ◽  
Independent Risk Factors ◽  
Group 2 ◽  
Group 1

Background: Studies have shown that survival after lung transplantation is impaired if extracorporeal membrane oxygenation (ECMO) support is implemented. We investigated the outcome and potential independent risk factors on survival in recipients undergoing lung transplantation with intraoperative ECMO support. Materials and methods: Medical records of recipients were retrospectively evaluated (January 2000-December 2014). Retransplantation and bridge to transplantation on ECMO were excluded. Recipients (n = 291) were divided into 2 groups: those who needed intraoperative ECMO support (Group 1, n = 134) and those who did not receive intraoperative ECMO support (Group 2, n = 157). Independent risk factors were identified by a stepwise backward regression analysis. Results: 1-year survival was 84.2% in Group 1 vs. 90.4% in Group 2, and 5-year survival was 52.8% in Group 1 vs. 70.5% in Group 2 (p = 0.002). Multivariate analysis indicated that recipient age (p = 0.001), renal replacement therapy (p = 0.001) and intraoperative ECMO support (p = 0.03) were significant risk factors for overall survival. The rate of postoperative early surgical complications was comparable between the two groups (p = 0.09). The number of patients requiring renal replacement therapy and experiencing late pulmonary complications was significantly higher in Group 1 (p = 0.02). Conclusions: Our data showed that lung transplantation with intraoperative ECMO support is associated with poor outcomes.

scholarly journals Concurrent Use of Renal Replacement Therapy during Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (2) ◽  
pp. 241
Author(s):  
Saikat Mitra ◽  
Ryan Ruiyang Ling ◽  
Chuen Seng Tan ◽  
Kiran Shekar ◽  
Graeme MacLaren ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Replacement Therapy ◽  
Observational Studies ◽  
Meta Analysis ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Lengths Of Stay ◽  
Concurrent Use

Patients supported with extracorporeal membrane oxygenation (ECMO) often receive renal replacement therapy (RRT). We conducted this systematic review and meta-analysis (between January 2000 and September 2020) to assess outcomes in patients who received RRT on ECMO. Random-effects meta-analyses were performed using R 3.6.1 and certainty of evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The primary outcome was pooled mortality. The duration of ECMO support and ICU/hospital lengths of stay were also investigated. Meta-regression analyses identified factors associated with mortality. A total of 5896 adult patients (from 24 observational studies and 1 randomised controlled trial) were included in this review. Overall pooled mortality due to concurrent use of RRT while on ECMO from observational studies was 63.0% (95% CI: 56.0–69.6%). In patients receiving RRT, mortality decreased by 20% in the last five years; the mean duration of ECMO support and ICU and hospital lengths of stay were 9.33 days (95% CI: 7.74–10.92), 15.76 days (95% CI: 12.83–18.69) and 28.47 days (95% CI: 22.13–34.81), respectively, with an 81% increased risk of death (RR: 1.81, 95% CI: 1.56–2.08, p < 0.001). RRT on ECMO was associated with higher mortality rates and a longer ICU/hospital stay compared to those without RRT. Future research should focus on minimizing renal dysfunction in ECMO patients and define the optimal timing of RRT initiation.

Renal replacement therapy in patients on extracorporeal membrane oxygenation support: Who and how

2020 ◽  
pp. 039139882098045
Author(s):  
Berhane Worku ◽  
Sandi Khin ◽  
Mario Gaudino ◽  
Ivan Gambardella ◽  
Erin Iannacone ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Replacement Therapy ◽  
Similar Efficacy ◽  
Ecmo Support ◽  
Dialysis Catheter ◽  
Ecmo Circuit ◽  
Membrane Oxygenation ◽  
Poor Outcomes

Patients undergoing extracorporeal membrane oxygenation (ECMO) support frequently develop renal failure requiring renal replacement therapy (RRT). RRT may be performed via a dialysis catheter based approach or via the ECMO circuit. We describe our experience with both techniques. A total of 68 patients undergoing ECMO support at our institution were retrospectively analyzed. Predictors of renal failure requiring RRT were determined. Patients undergoing RRT via a dialysis catheter were compared with those undergoing RRT via the ECMO circuit. 10 of the 68 patients required RRT support prior to ECMO. Of the remaining 58 patients, 25 (43%) required new RRT support on ECMO. Lower albumin levels and postcardiotomy shock were predictive of new renal failure requiring RRT on ECMO. RRT performed via the ECMO circuit demonstrated similar efficacy as via a dialysis catheter. Outcomes were much worse for patients requiring new RRT on ECMO support, with a doubling of the length of ECMO support and less that one-third the survival rate of patients not requiring RRT on ECMO support. New renal failure requiring RRT occurs in nearly one-half of patients on ECMO support, with poor outcomes. RRT may be performed via the ECMO circuit with similar efficacy as via a dialysis catheter.

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