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

Acute kidney injury is a frequent complication in patients requiring extracorporeal membrane oxygenation. A single-center retrospective analysis from a prospective observational database assessing the incidence of acute kidney injury in children undergoing extracorporeal membrane oxygenation, the use of continuous renal replacement therapy and its association with outcomes was performed. One hundred children were studied. Creatinine was normal in 33.3% of children at the beginning of extracorporeal membrane oxygenation, between 1.5 and 2 times its baseline levels in 18.4% of children (stage I acute kidney injury), between 2 and 3 times baseline levels (stage II) in 20.7%, and over 3 times baseline levels or requiring continuous renal replacement therapy (stage III) in 27.6% of the patients. Eighteen patients were on continuous renal replacement therapy before the beginning of extracorporeal membrane oxygenation, 81 required continuous renal replacement therapy during extracorporeal membrane oxygenation, and 38 after weaning from extracorporeal membrane oxygenation, but none of them did at discharge from the pediatric intensive care unit. Fifty-one children survived to pediatric intensive care unit discharge. Mortality was lower in children with normal kidney function or with stage I acute kidney injury at the beginning of extracorporeal membrane oxygenation than in those with stage II or III acute kidney injury (33.3% vs 58.3%, p = 0.021). Mortality in children requiring continuous renal replacement therapy during extracorporeal membrane oxygenation was 54.3% and 21.1% in the rest of patients (p < 0.01). We conclude that kidney function is significantly impaired in a high percentage of children undergoing extracorporeal membrane oxygenation and many of them are treated with continuous renal replacement therapy. Patients treated with continuous renal replacement therapy have a higher mortality than those with normal kidney function or stage I acute kidney injury at the beginning of extracorporeal membrane oxygenation. Most patients surviving to pediatric intensive care unit discharge recover normal renal function after weaning from extracorporeal membrane oxygenation.

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Review of acute kidney injury and continuous renal replacement therapy in pediatric extracorporeal membrane oxygenation

Indian Journal of Thoracic and Cardiovascular Surgery ◽

10.1007/s12055-020-01071-3 ◽

2020 ◽

Author(s):

Christopher Jenks ◽

Lakshmi Raman ◽

Archana Dhar

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Extracorporeal Membrane Oxygenation ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Membrane Oxygenation

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Optimizing renal replacement therapy for patients who need extracorporeal membrane oxygenation: cross-talk between two organ support machines

BMC Nephrology ◽

10.1186/s12882-019-1602-9 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Kianoush Kashani ◽

Marlies Ostermann

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Extracorporeal Membrane Oxygenation ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Cross Talk ◽

Kidney Injury ◽

Adverse Outcomes ◽

Organ Support ◽

Membrane Oxygenation

Abstract Following a substantial increase in the utilization of extracorporeal membrane oxygenation (ECMO) during the last decade, its associated benefits and complications, including acute kidney injury have become more apparent. Acute kidney injury requiring dialysis during the ECMO treatment is very common and is associated with adverse outcomes. Cross talk between ECMO and dialysis equipment has been debated in the literature in order to enhance the quality of dialysis and avoid its potential adverse events. Na et al. recently published the results of a prospective experiment by using three different methods for integration of the continuous renal replacement therapy device into the ECMO circuit. In this experiment, the investigators showed that by using three different connection strategies between continuous renal replacement therapy device and ECMO and the utilization of three separate structures of pressure control lines, the dialyzer lifespan could be optimized. In this commentary, following a brief review of the ECMO and dialysis devices history and cross talk, we discuss the findings by Na et al. and provide additional insights for future investigations.

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Title: Pheochromocytoma Crisis Rescued by Veno-Arterial Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

The American Surgeon ◽

10.1177/00031348211063573 ◽

2021 ◽

pp. 000313482110635

Author(s):

Toshihiro Nakayama ◽

Kyoji Ito ◽

Fuyuki Inagaki ◽

Wataru Miyake ◽

Daisuke Katagiri ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Extracorporeal Membrane Oxygenation ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Cardiopulmonary Arrest ◽

Tumor Resection ◽

Kidney Injury ◽

Membrane Oxygenation ◽

Va Ecmo

Pheochromocytoma is a rare catecholamine producing adrenal tumor. Pheochromocytoma crisis is a life-threatening condition inducing multiple organ failure and hemodynamic instability caused by too much catecholamines produced from pheochromocytoma. We report a 59-year-old woman with pheochromocytoma crisis rescued by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), continuous renal replacement therapy (CRRT), and interval tumor resection. In June 2020, the patient was taken to our institution complaining of headache and left lower back pain. The patient developed cardiopulmonary arrest while at the emergency department. After extracorporeal cardiopulmonary resuscitation, the patient required VA-ECMO for hemodynamic support, and subsequently CRRT for catecholamine removal and acute kidney injury. After 1 month of hemodynamic management, the patient underwent left adrenalectomy. The postoperative course was uneventful and she was discharged on postoperative day 23. CRRT would be a safe and feasible option for catecholamine control in patients with acute kidney injury in pheochromocytoma crisis.

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