Continuous Renal Replacement Therapy during Extracorporeal Membrane Oxygenation: Circuit Haemodynamics and Circuit Failure

Critical Care Nephrology – Research Article

Sansom B.a,b· Riley B.c· Udy A.c,d· Sriram S.a· Presneill J.a,b,d· Bellomo R.a,b,d,e

aDepartment of Intensive Care, The Royal Melbourne Hospital, Melbourne, VIC, Australia
bDepartment of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
cDepartment of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
dAustralian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
eDepartment of Intensive Care, The Austin, Melbourne, VIC, Australia

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Article / Publication Details

Received: June 03, 2022
Accepted: February 14, 2023
Published online: April 19, 2023

Number of Print Pages: 10
Number of Figures: 3
Number of Tables: 3

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

Abstract

Introduction: Treatment with continuous renal replacement therapy (CRRT) is common during extracorporeal membrane oxygenation (ECMO). Such ECMO-CRRT has specific technical characteristics, which may affect circuit life. Accordingly, we studied CRRT haemodynamics and circuit life during ECMO. Methods: ECMO and non-ECMO-CRRT treatments in two adult intensive care units were compared using data collected over a 3-year period. A potential predictor of circuit survival identified in a 60% training data subset as a time-varying covariate within a Cox proportional hazard model was subsequently assessed in the complementary remaining data (40%). Results: Median [interquartile range] CRRT circuit life was greater when associated with ECMO (28.8 [14.0–65.2] vs. 20.2 [9.8–40.2] h, p < 0.0001). Access, return, prefilter, and effluent pressures were also greater during ECMO. Higher ECMO flows were associated with higher access and return pressures. Classification and regression tree analysis identified an association between high access pressures and accelerated circuit failure, while both first access pressures ≥190 mm Hg (HR 1.58 [1.09–2.30]) and patient weight (HR 1.85 [1.15–2.97] third tertile vs. first tertile) were independently associated with circuit failure in a multivariable Cox model. Access dysfunction was associated with a stepwise increase in transfilter pressure, suggesting a potential mechanism of membrane injury. Conclusion: CRRT circuits used in conjunction with ECMO have a longer circuit life than usual CRRT despite exposure to higher circuit pressures. Markedly elevated access pressures, however, may predict early CRRT circuit failure during ECMO, possibly via progressive membrane thrombosis as evidenced by increased transfilter pressure gradients.

Received: June 03, 2022
Accepted: February 14, 2023
Published online: April 19, 2023

Number of Print Pages: 10
Number of Figures: 3
Number of Tables: 3

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: https://www.karger.com/BPU

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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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