In-parallel connected intermittent hemodialysis through ECMO does not affect hemodynamic parameters derived from transpulmonary thermodilution

Lahmer, Tobias; Mayr, Ulrich; Rasch, Sebastian; Baires, Gonzalo Batres; Schmid, Roland M.; Huber, Wolfgang

doi:10.1177/0267659117707816

Cited by 5 publications

(4 citation statements)

References 6 publications

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“…Finally, it is important to note that the transpulmonary thermodilution technique may be inaccurate during ECMO due to the potential loss of the indicator. Nonetheless, recent studies have demonstrated that the method can be applied during vv-ECMO, especially when the indicator is injected via the jugular vein ( 36 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

Veno-Venous Extracorporeal Membrane Oxygenation in Minipigs as a Robust Tool to Model Acute Kidney Injury: Technical Notes and Characteristics

Szabó-Biczók

Varga

et al. 2022

Front. Med.

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ObjectiveVeno-venous extracorporeal membrane oxygenation (vv-ECMO) can save lives in severe respiratory distress, but this innovative approach has serious side-effects and is accompanied by higher rates of iatrogenic morbidity. Our aims were, first, to establish a large animal model of vv-ECMO to study the pathomechanism of complications within a clinically relevant time frame and, second, to investigate renal reactions to increase the likelihood of identifying novel targets and to improve clinical outcomes of vv-ECMO-induced acute kidney injury (AKI).MethodsAnesthetized Vietnamese miniature pigs were used. After cannulation of the right jugular and femoral veins, vv-ECMO was started and maintained for 24 hrs. In Group 1 (n = 6) ECMO was followed by a further 6-hr post-ECMO period, while (n = 6) cannulation was performed without ECMO in the control group, with observation maintained for 30 h. Systemic hemodynamics, blood gas values and hour diuresis were monitored. Renal artery flow (RAF) was measured in the post-ECMO period with an ultrasonic flowmeter. At the end of the experiments, renal tissue samples were taken for histology to measure myeloperoxidase (MPO) and xanthine oxidoreductase (XOR) activity and to examine mitochondrial function with high-resolution respirometry (HRR, Oroboros, Austria). Plasma and urine samples were collected every 6 hrs to determine neutrophil gelatinase-associated lipocalin (NGAL) concentrations.ResultsDuring the post-ECMO period, RAF dropped (96.3 ± 21 vs. 223.6 ± 32 ml/min) and, similarly, hour diuresis was significantly lower as compared to the control group (3.25 ± 0.4 ml/h/kg vs. 4.83 ± 0.6 ml/h/kg). Renal histology demonstrated significant structural damage characteristic of ischemic injury in the tubular system. In the vv-ECMO group NGAL levels, rose significantly in both urine (4.24 ± 0.25 vs. 2.57 ± 0.26 ng/ml) and plasma samples (4.67 ± 0.1 vs. 3.22 ± 0.2 ng/ml), while tissue XOR (5.88 ± 0.8 vs. 2.57 ± 0.2 pmol/min/mg protein) and MPO (11.93 ± 2.5 vs. 4.34 ± 0.6 mU/mg protein) activity was elevated. HRR showed renal mitochondrial dysfunction, including a significant drop in complex-I-dependent oxidative capacity (174.93 ± 12.7 vs. 249 ± 30.07 pmol/s/ml).ConclusionSignificantly decreased renal function with signs of structural damage and impaired mitochondrial function developed in the vv-ECMO group. The vv-ECMO-induced acute renal impairment in this 30-hr research protocol provides a good basis to study the pathomechanism, biomarker combinations or possible therapeutic possibilities for AKI.

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Section: Discussionmentioning

confidence: 99%

Veno-Venous Extracorporeal Membrane Oxygenation in Minipigs as a Robust Tool to Model Acute Kidney Injury: Technical Notes and Characteristics

Szabó-Biczók

Varga

et al. 2022

Front. Med.

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“…10,11 Although the concept of an integrated ECMO-SLED is mentioned in literature, evidence lacks beyond anecdotal notion. [12][13][14] Evidence concerning feasibility of an integrated ECMO-SLED is especially pressing because outbreaks of COVID-19 can lead to regional shortages in RRT devices and staff. 15,16 Consequently, ECOS experienced centers involved in the treatment of severe COVID-19 will profit from a study addressing the integration of SLED into an ECMO circuit.…”

Section: Introductionmentioning

confidence: 99%

“…This is surprising because SLEDs are widely used for RRT and non‐inferior compared with continuous RRT procedures 10,11 . Although the concept of an integrated ECMO‐SLED is mentioned in literature, evidence lacks beyond anecdotal notion 12–14 …”

Section: Introductionmentioning

confidence: 99%

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Integration of sustained low‐efficiency dialysis into extracorporeal membrane oxygenation circuit in critically ill COVID‐19 patients: A feasibility study

et al. 2022

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Background Severe COVID‐19 can necessitate multiple organ support including veno‐venous extracorporeal membrane oxygenation (vvECMO) and renal replacement therapy. The therapy can be complicated by venous thromboembolism due to COVID‐19‐related hypercoagulability, thus restricting vascular access beyond the vvECMO cannula. Although continuous renal replacement therapy can be performed via a vvECMO circuit, studies addressing sustained low‐efficiency dialysis (SLED) integration into vvECMO circuits are scarce. Here we address the lack of evidence by evaluating feasibility of SLED integration into vvECMO circuits. Methods Retrospective cohort study on nine critically ill COVID‐19 patients, treated with integrated ECMO‐SLED on a single intensive care unit at a tertiary healthcare facility between December 2020 and November 2021. The SLED circuits were established between the accessory arterial oxygenator outlets of a double‐oxygenator vvECMO setup. Data on filter survival, quality of dialysis, and volume management were collected and compared with an internal control group receiving single SLED. Results This study demonstrates general feasibility of SLED integration into existing vvECMO circuits. Filter lifespans of ECMO‐SLED compared with single SLED are significantly prolonged (median 18.3 h vs. 10.3 h, p < 0.01). ECMO‐SLED treatment is furthermore able to sufficiently normalize creatinine, blood urea nitrogen, and serum sodium, and allows for adequate ultrafiltration rates. Conclusions We can show that ECMO‐SLED is practical, safe, results in adequate dialysis quality and enables sufficient electrolyte and volume management. Our data indicate that SLED devices can serve as potential alternative to continuous‐veno‐venous‐hemodialysis for integration in vvECMO circuits.

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Options in extracorporeal support of multiple organ failure

Huber

Garibay²

2020

Med Klin Intensivmed Notfmed

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In-parallel connected intermittent hemodialysis through ECMO does not affect hemodynamic parameters derived from transpulmonary thermodilution

Abstract: Hemodynamic monitoring using TPTD and PCA during ECMO/RRT is feasible and provides reliable results.

Cited by 5 publications

References 6 publications

Veno-Venous Extracorporeal Membrane Oxygenation in Minipigs as a Robust Tool to Model Acute Kidney Injury: Technical Notes and Characteristics

Veno-Venous Extracorporeal Membrane Oxygenation in Minipigs as a Robust Tool to Model Acute Kidney Injury: Technical Notes and Characteristics

Integration of sustained low‐efficiency dialysis into extracorporeal membrane oxygenation circuit in critically ill COVID‐19 patients: A feasibility study

Options in extracorporeal support of multiple organ failure

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