Continuous renal replacement therapy during extracorporeal membrane oxygenation: why, when and how?

Area of Science:

• Critical Care Medicine
• Nephrology
• Cardiovascular Engineering

Background:

• Extracorporeal membrane oxygenation (ECMO) use is rising, increasing the incidence of acute kidney injury (AKI) in patients.
• AKI in ECMO patients frequently necessitates renal replacement therapy (RRT), posing significant management challenges.

Purpose of the Study:

• To review and compare various strategies for combining RRT with ECMO.
• To outline the advantages and disadvantages of different RRT-ECMO integration techniques.

Main Methods:

• Review of current literature on RRT modalities used in conjunction with ECMO.
• Analysis of integrated (in-line) versus parallel RRT systems in ECMO patients.

Main Results:

• Fluid overload is the primary indication for RRT in ECMO patients, with continuous renal replacement therapy (CRRT) being the preferred method.
• CRRT can be delivered via integrated or parallel systems, each with unique implications for circuit pressures, hemolysys, and solute clearance.
• No current evidence suggests that different RRT-ECMO combination methods affect patient mortality.

Conclusions:

• Individualized timing for CRRT initiation in ECMO patients is crucial, based on fluid status and metabolic derangements.
• A thorough understanding of the technical aspects and potential complications of integrated and parallel RRT systems is essential for optimal patient care.
• Further research may be needed to elucidate the impact of specific RRT-ECMO configurations on patient outcomes.