Impact of CRRT in Patients with PARDS Treated with VV-ECMO

Overview

Journal Membranes (Basel)

Date 2021 Apr 3

PMID 33799847

Authors

Sebastien Redant

Oceane Barbance

Ashita Tolwani

Xavier Beretta-Piccoli

Jacques Massaut

David De Bels

Fabio S Taccone

Patrick M Honore

Dominique Biarent

Affiliations

Soon will be listed here.

Abstract

Methods: We conducted a retrospective 7-year study of patients with PARDS requiring ECMO and divided them into those requiring CRRT and those not requiring CRRT. We calculated severity of illness scores, the amount of blood products administered to both groups, and determined the impact of CRRT on mortality and morbidity.

Results: We found no significant difference in severity of illness scores except the vasoactive inotropic score (VIS, 45 ± 71 vs. 139 ± 251, = 0.042), which was significantly elevated during the initiation and the first three days of ECMO. CRRT was associated with an increase in the use of blood products and noradrenaline ( < 0.01) without changing ECMO duration, length of PICU stay or mortality.

Conclusion: The addition of CRRT to ECMO is associated with a greater consumption of blood products but no increase in mortality.

References

Valentine S, Sapru A, Higgerson R, Spinella P, Flori H, Graham D . Fluid balance in critically ill children with acute lung injury. Crit Care Med. 2012; 40(10):2883-9. PMC: 3455114. DOI: 10.1097/CCM.0b013e31825bc54d. View

Betrus C, Remenapp R, Charpie J, Kudelka T, Brophy P, Smoyer W . Enhanced hemolysis in pediatric patients requiring extracorporeal membrane oxygenation and continuous renal replacement therapy. Ann Thorac Cardiovasc Surg. 2008; 13(6):378-83. View

Urlesberger B, Zobel G, Zenz W, Maurer U, Reiterer F, Riccabona M . Activation of the clotting system during extracorporeal membrane oxygenation in term newborn infants. J Pediatr. 1996; 129(2):264-8. DOI: 10.1016/s0022-3476(96)70252-4. View

Jeney V . Pro-Inflammatory Actions of Red Blood Cell-Derived DAMPs. Exp Suppl. 2018; 108:211-233. DOI: 10.1007/978-3-319-89390-7_9. View

Schmidt M, Bailey M, Kelly J, Hodgson C, Cooper D, Scheinkestel C . Impact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation. Intensive Care Med. 2014; 40(9):1256-66. PMC: 7094895. DOI: 10.1007/s00134-014-3360-2. View

Ricci Z, Morelli S, Favia I, Garisto C, Brancaccio G, Picardo S . Neutrophil gelatinase-associated lipocalin levels during extracorporeal membrane oxygenation in critically ill children with congenital heart disease: preliminary experience. Pediatr Crit Care Med. 2010; 13(1):e51-4. DOI: 10.1097/PCC.0b013e3181fe4717. View

Zimmerman J, Akhtar S, Caldwell E, Rubenfeld G . Incidence and outcomes of pediatric acute lung injury. Pediatrics. 2009; 124(1):87-95. DOI: 10.1542/peds.2007-2462. View

Reed R, Rutledge J . Laboratory and clinical predictors of thrombosis and hemorrhage in 29 pediatric extracorporeal membrane oxygenation nonsurvivors. Pediatr Dev Pathol. 2010; 13(5):385-92. DOI: 10.2350/09-09-0704-OA.1. View

Mildner R, Taub N, Vyas J, Killer H, Firmin R, Field D . Cytokine imbalance in infants receiving extracorporeal membrane oxygenation for respiratory failure. Biol Neonate. 2005; 88(4):321-7. DOI: 10.1159/000087630. View

10.

Kolovos N, Bratton S, Moler F, Bove E, Ohye R, Bartlett R . Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery. Ann Thorac Surg. 2003; 76(5):1435-41. DOI: 10.1016/s0003-4975(03)00898-1. View

11.

Sutherland S, Zappitelli M, Alexander S, Chua A, Brophy P, Bunchman T . Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010; 55(2):316-25. DOI: 10.1053/j.ajkd.2009.10.048. View

12.

Askenazi D, Ambalavanan N, Hamilton K, Cutter G, Laney D, Kaslow R . Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2010; 12(1):e1-6. DOI: 10.1097/PCC.0b013e3181d8e348. View

13.

Flori H, Church G, Liu K, Gildengorin G, Matthay M . Positive fluid balance is associated with higher mortality and prolonged mechanical ventilation in pediatric patients with acute lung injury. Crit Care Res Pract. 2011; 2011:854142. PMC: 3114079. DOI: 10.1155/2011/854142. View

14.

Haneya A, Diez C, Philipp A, Bein T, Mueller T, Schmid C . Impact of Acute Kidney Injury on Outcome in Patients With Severe Acute Respiratory Failure Receiving Extracorporeal Membrane Oxygenation. Crit Care Med. 2015; 43(9):1898-906. DOI: 10.1097/CCM.0000000000001141. View

15.

Selewski D, Cornell T, Lombel R, Blatt N, Han Y, Mottes T . Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med. 2011; 37(7):1166-73. PMC: 3315181. DOI: 10.1007/s00134-011-2231-3. View

16.

Antonucci E, Lamanna I, Fagnoul D, Vincent J, De Backer D, Taccone F . The Impact of Renal Failure and Renal Replacement Therapy on Outcome During Extracorporeal Membrane Oxygenation Therapy. Artif Organs. 2016; 40(8):746-54. DOI: 10.1111/aor.12695. View

17.

Burnstock G . Purinergic Signaling in the Cardiovascular System. Circ Res. 2017; 120(1):207-228. DOI: 10.1161/CIRCRESAHA.116.309726. View

18.

Fleming G, Askenazi D, Bridges B, Cooper D, Paden M, Selewski D . A multicenter international survey of renal supportive therapy during ECMO: the Kidney Intervention During Extracorporeal Membrane Oxygenation (KIDMO) group. ASAIO J. 2012; 58(4):407-14. PMC: 5486948. DOI: 10.1097/MAT.0b013e3182579218. View

19.

Askenazi D, Selewski D, Paden M, Cooper D, Bridges B, Zappitelli M . Renal replacement therapy in critically ill patients receiving extracorporeal membrane oxygenation. Clin J Am Soc Nephrol. 2012; 7(8):1328-36. PMC: 5486859. DOI: 10.2215/CJN.12731211. View

20.

Gbadegesin R, Zhao S, Charpie J, Brophy P, Smoyer W, Lin J . Significance of hemolysis on extracorporeal life support after cardiac surgery in children. Pediatr Nephrol. 2008; 24(3):589-95. DOI: 10.1007/s00467-008-1047-z. View