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[Continuous renal replacement therapy combined with extracorporeal membrane oxygenation for pediatric cardiopulmonary
1Department of Critical Care Medicine, Shanghai Children's Hospital, Institute of Pediatric Critical Care, Shanghai Jiao Tong University, Shanghai 200040, China.
Insights
Continuous renal replacement therapy (CRRT) combined with extracorporeal membrane oxygenation (ECMO) effectively treats pediatric cardiopulmonary failure. This combination alleviates fluid overload and improves kidney function, showing comparable survival rates to ECMO alone.
Area of Science:
- Pediatric Critical Care Medicine
- Renal Replacement Therapy
- Cardiopulmonary Support
Background:
- Pediatric patients with cardiopulmonary failure often require advanced life support.
- Acute kidney injury (AKI) and fluid overload are common complications in these critically ill children.
- Extracorporeal membrane oxygenation (ECMO) provides cardiopulmonary support, but renal dysfunction can complicate management.
Purpose of the Study:
- To evaluate the efficacy and safety of combining continuous renal replacement therapy (CRRT) with ECMO in pediatric patients.
- To assess the impact of this combined therapy on fluid balance and renal function.
- To compare outcomes, including survival rates, between patients receiving ECMO with CRRT and those receiving ECMO alone.
Main Methods:
- Retrospective analysis of medical records from pediatric intensive care unit (PICU) patients treated with ECMO.
- Comparison of a group receiving ECMO combined with CRRT (ECMO+CRRT) for AKI or fluid overload against a group receiving ECMO only.
- Analysis of patient demographics, clinical characteristics, ECMO/CRRT details, complications, and survival rates.
Main Results:
- Patients in the ECMO+CRRT group had significantly higher serum creatinine levels, indicating more severe kidney injury or overload.
- The incidence of thrombocytopenia was higher in the ECMO+CRRT group.
- No significant differences were observed in ECMO duration, successful weaning rates, or discharge survival rates between the two groups.
Conclusions:
- The combination of CRRT and ECMO is an effective and safe strategy for managing fluid overload and improving kidney function in pediatric patients with cardiopulmonary failure.
- While CRRT may be associated with increased thrombocytopenia, it does not negatively impact overall survival.
- This combined approach offers a viable rescue option for critically ill children requiring advanced life support.
Abstract:
Objective: To explore the effectiveness and safety of continuous renal replacement therapy (CRRT) combined with extracorporeal membrane oxygenation (ECMO) on rescuing pediatric patients with cardiopulmonary failure. Methods: The medical records of patients treated with ECMO admitted to pediatric intensive care unit (PICU) in Shanghai Children's Hospital from December 2015 to November 2017 were retrospectively extracted. There were 14 patients treated with ECMO combined with CRRT (ECMO+ CRRT group) due to acute kidney injury (AKI) or fluid overload, while 11 cases treated with ECMO only. The demographics and clinical characteristics of patients, the indications, details and complications of ECMO and CRRT support, and the survival rates were analyzed. Results: A total of 25 cases including 15 boys and 10 girls with cardiopulmonary failure treated with ECMO were enrolled in this study, whose median age and body weight were 9 (1-117) months and 10 (2-42) kg. The median duration of ECMO support was 199.2 h, and the median duration of CRRT was 78.6 h. Among the 14 cases in ECMO + CRRT group, 12 cases were treated with CRRT connected to ECMO pipeline, and 2 other cases were treated with independently operated CRRT. The serum level of creatinine was significantly higher in ECMO+ CRRT group than that in ECMO group (53 (22- 126) vs. 29 (12- 92) μmol/L, Z=-2.208, P=0.043). There was no significant difference in running time between ECMO+CRRT group and ECMO group ((257±203) vs. (122± 83) h, t=-2.062, P=0.051). And the incidence of thrombocytopenia was higher in ECMO+CRRT group than that in ECMO group (10/14 vs. 3/11 , χ(2)=4.812, P=0.028). There were no differences in the successful weaning rate and discharge survival rate between ECMO + CRRT and ECMO group (9 vs. 8, χ(2)= 0.203, P= 0.652 and 8 vs. 8, χ(2)= 0.659, P= 0.417, respectively). Conclusion: The combination of CRRT and ECMO is an effective and safe treatment to alleviate fluid overload and improve kidney function in pediatric patients with cardiopulmonary failure.
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