Safely combining renal replacement therapy and extracorporeal membrane oxygenation

Area of Science:

• Critical Care Medicine
• Nephrology
• Cardiovascular Engineering

Background:

• Extracorporeal membrane oxygenation (ECMO) is vital for acute circulatory and respiratory failure.
• ECMO patients have a high risk (approx. 50%) of acute kidney injury requiring renal replacement therapy (RRT).
• Integrating RRT into ECMO circuits may reduce vascular access complications but requires specialized knowledge.

Purpose of the Study:

• To describe a safe and effective method for combining RRT and ECMO circuits.
• To provide guidance on managing integrated RRT-ECMO systems using specific consoles.
• To outline strategies for managing elevated pressures within the RRT circuit during combined therapy.

Main Methods:

• A method for integrating RRT with ECMO using Cardiohelp® and Xenios® consoles is presented.
• RRT is connected to the positive pressure sections of the ECMO circuit.
• The RRT return line is placed before the oxygenator, without altering the ECMO circuit, to prevent air embolism.

Main Results:

• The described configuration minimizes the risk of air embolism in the ECMO circuit.
• The ECMO oxygenator acts as a safeguard against arterial air embolism.
• Factors influencing RRT circuit pressures and management strategies for high pressures are discussed.

Conclusions:

• Safe and effective integration of RRT and ECMO is achievable with careful technique.
• The proposed method enhances patient safety by mitigating air embolism risks.
• Understanding circuit dynamics is crucial for optimizing combined RRT-ECMO therapy.