Abstract
ObjectivesPatients receiving extracorporeal membrane oxygenation (ECMO) often require renal replacement therapy (RRT). Insertion of a dialysis catheter may be challenging in these patients. Direct connection of RRT lines on an ECMO circuit (DCRE) may help circumvent this problem. However, no guidelines exist on this issue, and various types of practices may exist. This study aimed to describe the practice of RTT in patients on ECMO, including the direct connection of RTT lines on the ECMO circuit (DCRE) as well as the perception and concerns related to this technique.DesignInternational surveySetting.Worldwide diffusion via email.Subject.Professionals involved in the management of ECMOInterventions:Respondents’ characteristics were analyzed. Respondents always or often performing RRT via the ECMO circuit were classified in the ECMO group, and those using a dialysis catheter were classified in the DC group. The two groups were compared regarding their characteristics and their practice in ECMO and RRT. Participants were asked about their perceptions of DCRE and actual problems previously encountered. Measurements and Main Results:From March 2019 to October 2019, 298 participants answered the questionnaire from 46 different countries. Only 28% were working in pediatric departments. Among the 165 participants commonly performing RRT in patients on ECMO, 100 (61%) performed mainly RRT via the ECMO circuit, and 65 (39%) performed RRT via DC. Pediatric practice and a longer experience were the only noticeable characteristics of the ECMO group. The most reported fear regarding DCRE was the risk of air embolism (n=84, 28%), but the most encountered problem was unmanageable pressure alarms in RRT devices.ConclusionThe present study showed significant heterogeneity in RRT practices in patients on ECMO. The lower experience of the DC group, the high rates of fears toward DCRE, and pressure alarm issues suggested that protocols and training may overcome reluctance and technical difficulties. Further research may provide data to back specific guidelines. Take-home messageThe present study showed significant heterogeneity in RRT practices in patients on ECMO showing lower experience, fears and pressure alarm issues as barriers for direct connection of RRT lines on ECMO circuit, suggesting needs for protocols, training and specific guidelines.140-character TweetLow experience, fears and pressure alarm issues as barriers for direct connection of RRT lines on ECMO circuit, suggesting needs for protocols, training and specific guidelines.
Veno-Venous Extracorporeal Membrane Oxygenation: Anesthetic Management for Massive Intracranial Hemorrhage in H1N1 Infection
