Tandem Extracorporeal Blood Purification/Support Therapies in Critically Ill Children: A Literature Review

To evaluate the current evidence, clinical indications, methodologies, outcomes, and challenges associated with tandem extracorporeal blood purification/support therapies (EBP/STs) in critically ill children.

A literature review of peer-reviewed articles, clinical guidelines, and existing literature related to continuous renal replacement therapy, therapeutic plasma exchange, extracorporeal membrane oxygenation, and their concurrent use in critically ill children.

Studies were included if they described tandem use of EBP/ST modalities in children, including case series, observational studies, and expert reviews. Studies focusing exclusively on adult populations or single modality therapy were excluded.

Key data points extracted were patient population, clinical indication for tandem therapy, type and sequence of EBP/ST modality used, reported outcomes, and complications. Emphasis was placed on child-specific applications, safety profiles, and treatment protocols.

Tandem EBP/ST are increasingly used to treat children with complex conditions such as sepsis-induced multiple organ failure, acute liver failure, and thrombocytopenia-associated multiple organ dysfunction syndrome. This review synthesizes the reported risks, benefits, and proposed protocols for tandem therapy use in PICUs. Benefits include reduced procedural downtime, optimized vascular access, and enhanced therapeutic efficiency. However, tandem therapies remain off-label, with widely variable clinical protocols, lack of children-specific guidelines, and increased risk of complications such as hypocalcemia and hemodynamic instability, limiting their widespread adoption.

Tandem EBP/STs remain an emerging but incompletely standardized intervention in pediatric critical care. While they offer potential benefits such as improved procedural efficiency and reduced vascular access requirements, their use is limited by heterogeneous protocols, off-label application, and risk of complications. Efforts toward developing standardized guidelines, enhancing multidisciplinary training, and establishing multicenter registries may help optimize their safe and effective use in critically ill children.