How to perform a haemodialysis using the arterial and venous lines of an extracorporeal life support

Abstract

Continuous renal replacement therapy is particularly suited in the setting of acute renal failure, occurring after cardiac surgery, in patients requiring extracorporeal life support (ECLS) or membrane oxygenation. In such patients, temporary catheters are not necessary since the circuit of haemodialysis or haemofiltration may be connected on the ECLS cannulae. We report how to modify a classical ECLS circuit to connect directly the haemodialysis (Prismaflex device, Gambro-Hospal, Lyon, France) to the ECLS. We also detail parameters used to initiate the haemodialysis. Actually, we modify all our ECLS circuits as described here, at implantation time, allowing rapid haemodialysis initiations. Since 2004, 21 patients have been treated, as described here, without supplemental mortality or related complication.

Position article for the use of extracorporeal life support in adult patients

“…A thorough visual inspection of the recipient artery is also possible. Employing these techniques even hemodialysis through the use of these cannulas is possible [15].…”

Hemofiltration Is Not Associated With Increased Mortality in Children Receiving Extracorporeal Membrane Oxygenation*

“…Setting: Tertiary PICU. CRRT can be performed either by in-line hemofiltration, connecting a CRRT machine to the ECMO circuit, or by running two extracorporeal circuits in parallel (7,8). Interventions: None.…”

Untitled

“…29 Rubin and associates reported that 75% of their patients required temporary hemodialysis or hemofiltration without delay. 30 Our opinion is that subclavian artery cannulation provides a safe and perhaps improved means for providing VA-ECMO support. Additional studies will be required to quantify potential benefits seen in these patients compared with those who are bridged to transplant with mechanical circulatory support using more conventional cannulation strategies.…”