scholarly journals Continuous renal replacement therapy and extracorporeal membrane oxygenation: implications in the COVID-19 era

Perfusion ◽  
2021 ◽  
pp. 026765912110425
Author(s):  
Sophia H Roberts ◽  
Matthew L Goodwin ◽  
Christopher M Bobba ◽  
Omar Al-Qudsi ◽  
S Veena Satyapriya ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Replacement Therapy ◽  
Rescue Therapy ◽  
Multiple Organ ◽  
World Health ◽  
The Novel ◽  
Ecmo Circuit ◽  
Membrane Oxygenation ◽  
Health Organization

The novel severe acute respiratory syndrome coronavirus 2, SARS-CoV-2 (coronavirus Disease 19 (COVID-19)) was identified as the causative agent of viral pneumonias in Wuhan, China in December 2019, and has emerged as a pandemic causing acute respiratory distress syndrome (ARDS) and multiple organ dysfunction. Interim guidance by the World Health Organization states that extracorporeal membrane oxygenation (ECMO) should be considered as a rescue therapy in COVID-19-related ARDS. International registries tracking ECMO in COVID-19 patients reveal a 21%–70% incidence of acute renal injury requiring renal replacement therapy (RRT) during ECMO support. The indications for initiating RRT in patients on ECMO are similar to those for patients not requiring ECMO. RRT can be administered during ECMO via a temporary dialysis catheter, placement of a circuit in-line hemofilter, or direct connection of continuous RRT in-line with the ECMO circuit. Here we review methods for RRT during ECMO, RRT initiation and timing during ECMO, anticoagulation strategies, and novel cytokine filtration approaches to minimize COVID-19’s pathophysiological impact.

scholarly journals Extracorporeal Membrane Oxygenation for Acute Respiratory and Cardiac Failure

2021 ◽  
Vol 33 ◽  
pp. 55-64
Author(s):  
Hideshi ITOH ◽  
Nguyen The Binh ◽  
Le Ngoc Thanh ◽  
Hitomi Ando ◽  
Naohiro Inagawa ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Failure ◽  
Rescue Therapy ◽  
World Health ◽  
Lung Protective Ventilation ◽  
Critical Situation ◽  
Membrane Oxygenation ◽  
The World ◽  
Refractory Hypoxemia ◽  
Health Organization

Extracorporeal Membrane Oxygenation (ECMO) is widely used for acute respiratory and cardiac failure in critical situations as mechanical circulatory and respiratory support systems. Historically, ECMO had been two arguments both for and against using in critical situation. Despite the widespread adoption of ECMO in critical situation, the use of ECMO remains associated with significant morbidity and mortality. In 2019, an outbreak of pneumonia caused by severe acute respiratory distress syndrome (ARDS) by corona virus 2 (SARS-CoV-2) has occurred in China. SARS-CoV-2 has rapidly spread out the community of whole over the world, and cause severe respiratory failure disease (COVID-19) associated mortality and lack of immunization and treatment. According to the interim guidance formulated by the World Health Organization (WHO), ECMO should be considered as a rescue therapy or COVID-19 with refractory hypoxemia despite lung protective ventilation. The focus of this review will be on the physiological aspects of respiratory and cardiac ECMO.

scholarly journals Renal Replacement Therapy for Patients Requiring Extracorporeal Membrane Oxygenation: A Multicenter International Survey

2021 ◽  
Author(s):  
Michael THY ◽  
Pascal Augustin ◽  
Alexy Tran-Dinh ◽  
Philippe Montravers ◽  
Christian de Tymowski
Keyword(s):  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Replacement Therapy ◽  
Air Embolism ◽  
Significant Heterogeneity ◽  
Direct Connection ◽  
Dialysis Catheter ◽  
International Survey ◽  
Ecmo Circuit ◽  
Membrane Oxygenation

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.

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.

scholarly journals Continuous renal replacement therapy in patients receiving extracorporeal membrane oxygenation therapy

2022 ◽  
pp. 175114372110670
Author(s):  
Meera Raja ◽  
Ricardo Leal ◽  
James Doyle
Keyword(s):  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Ecmo Circuit ◽  
Membrane Oxygenation ◽  
Venous Cannula ◽  
In Series ◽  
Air Embolus ◽  
Average Filter

Methods of continuous renal replacement therapy (CRRT) in extracorporeal membrane oxygenation (ECMO) patients include dedicated central venous cannula (CVC) (vCRRT), in-series with filter connected to ECMO circuit (eCRRT) or in-line with haemodiafilter incorporated within ECMO circuit. We assessed the efficacy and safety of eCRRT versus vCRRT in 20 ECMO-CRRT patients. Average filter lifespan was 42 vs 28 hours and filter runs completing 72hours were 40% vs 13.8% (eCRRT vs vCRRT, respectively). One incidence of ECMO circuit air embolus occurred (vCRRT). eCRRT achieved adequate filtration and increased filter lifespan, and has become our default for ECMO-CRRT if a pre-existing dialysis CVC is not present.

Sign in / Sign up

Export Citation Format

Share Document