Shum HP, Ming-Chit Kwan A, Chan KC, Yan WW.; ASAIO J. 2014 Apr 10. [Epub ahead of print]
Patients on extracorporeal membrane oxygenation (ECMO) frequently requires continuous renal replacement therapy (CRRT). Additional anticoagulation for the CRRT circuit is usually not employed, but this may increases the risk of clot embolisation, which shortens oxygenator lifespan and increases patient's risk. We report our experience on the use of regional citrate anticoagulation continuous venovenous haemofiltration (RCA-CVVH) connected to an ECMO circuit, which could be useful during low heparin / heparin-free ECMO situations.
RCA-CVVH was performed using AK200US machine with a blood flow of 150ml/min, Acid Citrate Dextrose Solution pre-filter infusion at 240ml/hr, ultrafiltration rate of 2040ml/hr, and post-dilutional online generated replacement fluid infused as appropriate. The circuit was aimed to run for 30hrs. From May 2009 – May 2013, 63 patients received ECMO and 29 received RCA-CVVH. The median total CVVH time was 131hrs (IQR: 61-224hrs) and haemofilter life was 27.2hrs (IQR: 25.7-28.5hrs). No haemofilter or oxygenator was changed due to clotting. Their hospital mortality was 27.6%. There were eight patients, who were judged to be too sick for anticoagulation, received predilution CRRT during the same period. Their hospital mortality was 75%. In conclusion, online post-dilutional RCA-CVVH connected to an ECMO circuit is a feasible, safe, and effective CRRT technique.
Weblink here