Haemofiltration in newborns treated with extracorporeal membrane oxygenation: a case-comparison study

Abstract

IntroductionExtracorporeal membrane oxygenation is a supportive cardiopulmonary bypass technique for patients with acute reversible cardiovascular or respiratory failure. Favourable effects of haemofiltration during cardiopulmonary bypass instigated the use of this technique in infants on extracorporeal membrane oxygenation. The current study aimed at comparing clinical outcomes of newborns on extracorporeal membrane oxygenation with and without continuous haemofiltration.MethodsDemographic data of newborns treated with haemofiltration during extracorporeal membrane oxygenation were compared with those of patients treated without haemofiltration in a retrospective 1:3 case-comparison study. Primary outcome parameters were time on extracorporeal membrane oxygenation, time until extubation after decannulation, mortality and potential cost reduction. Secondary outcome parameters were total and mean fluid balance, urine output in mL/kg/day, dose of vasopressors, blood products and fluid bolus infusions, serum creatinin, urea and albumin levels.ResultsFifteen patients with haemofiltration (HF group) were compared with 46 patients without haemofiltration (control group). Time on extracorporeal membrane oxygenation was significantly shorter in the HF group: 98 hours (interquartile range (IQR) = 48 to 187 hours) versus 126 hours (IQR = 24 to 403 hours) in the control group (P = 0.02). Time from decannulation until extubation was shorter as well: 2.5 days (IQR = 0 to 6.4 days) versus 4.8 days (IQR = 0 to 121.5 days; P = 0.04). The calculated cost reduction was €5000 per extracorporeal membrane oxygenation run. There were no significant differences in mortality. Patients in the HF group needed fewer blood transfusions: 0.9 mL/kg/day (IQR = 0.2 to 2.7 mL/kg/day) versus 1.8 mL/kg/day (IQR = 0.8 to 2.9 mL/kg/day) in the control group (P< 0.001). Consequently the number of blood units used was significantly lower in the HF group (P< 0.001). There was no significant difference in inotropic support or other fluid resuscitation.ConclusionsAdding continuous haemofiltration to the extracorporeal membrane oxygenation circuit in newborns improves outcome by significantly reducing time on extracorporeal membrane oxygenation and on mechanical ventilation, because of better fluid management and a possible reduction of capillary leakage syndrome. Fewer blood transfusions are needed. All in all, overall costs per extracorporeal membrane oxygenation run will be lower.

The first, second and third wave of pandemic influenza A (H1N1)pdm09 in North Denmark Region 2009–2011: a population‐based study of hospitalizations

“…A majority of hospitalized patients requiring therapy in ICUs were adults <65 years who on admission had respiratory failure due mainly to primary influenza pneumonia in agreement with other observations,8, 15, 21, 22, 23, 24 and in clear contrast to seasonal influenza. The number of patients that are admitted to an ICU may vary related to criteria used by the institution.…”

“…Immediate initiation of oseltamivir treatment potentially reduces the risk of complications and requirement for ICU admission,14 and we observed no difference in time from diagnosis to initiation of antiviral therapy between the second and third wave. In the critically ill patients with pandemic influenza, it has been suggested to increase the dose of oseltamivir to 300 mg daily,15, 16 but this is not supported by clinical data and the pharmacokinetics of oseltamivir 75 mg twice daily in intensive care patients have been demonstrated to be comparable to patients with mild disease 17. The majority of our patients were treated with 150 mg daily.…”

“…The number of patients that are admitted to an ICU may vary related to criteria used by the institution. Consequently, the mortality in ICU differs has been reported from 11% to 25% 15, 21, 22, 23, 24, 25. Many patients with severe disease have co‐morbidities, but it is well described that fatalities from pandemic influenza may occur in previously healthy subjects.…”

Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

“…Hence, early initiation of CRRT before the onset of fluid overload should be considered in patients on ECMO. Blijdorp et al observed that initiating preemptive CRRT during ECMO in neonatal patients improved outcomes by decreasing time on ECMO due to improved fluid management [6,7]. It has also been shown that odds ratio for death was higher when CRRT was started later and longer it was performed.…”

CKD and Hypertension during Long-Term Follow-Up in Children and Adolescents Previously Treated with Extracorporeal Membrane Oxygenation

“…The ECMO circuit was primed as described elsewhere (23). From 2005 onward, all patients received by protocol preemptive continuous hemofiltration (CH) by placement of a hemofilter (Multiflow 60; Hospal, Lyon, France) parallel to the ECMO circuit and distal to the roller pump.…”