Outcomes among Patients Treated with Renal Replacement Therapy during Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Study

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are modalities used in critically ill patients suffering organ failure and metabolic derangements. Although the effects of CRRT have been extensively studied, the impact of simultaneous CRRT and ECMO is less well described. The purpose of this study is to evaluate the incidence and the impact of CRRT on outcomes of patients receiving ECMO. Methods: A single center, retrospective chart review was conducted for patients receiving ECMO therapy over a 6-year period. Patients who underwent combined ECMO and CRRT were compared to those who underwent ECMO alone. Intergroup statistical comparisons were performed using Wilcoxon/ Kruskal-Wallis and chi-square tests. Logistic regression was performed to identify independent risk factors for mortality. Results:The demographic and clinical data of 92 patients who underwent ECMO at our center were reviewed including primary diagnosis, indications for and mode of ECMO support, illness severity, oxygenation index, vasopressor requirement, and presence of acute kidney injury. In those patients that required ECMO with CRRT, we reviewed urine output prior to initiation, modality used, prescribed dose, net fluid balance after 72 h, requirement of renal replacement therapy (RRT) at discharge, and use of diuretics prior to RRT initiation. Our primary endpoint was survival to hospital discharge. During the study period, 48 patients required the combination of ECMO with CRRT. Twenty-nine of these patients survived to hospital discharge. Of the 29 survivors, 6 were dialysis dependent at hospital discharge. The mortality rate was 39.5% with combined ECMO/CRRT compared to 31.4% among those receiving ECMO alone (p = 0.074). Of those receiving combined therapy, nonsurvivors were more likely to have a significantly positive net fluid balance at 72 h (p = 0.001). A multivariate linear regression analysis showed net positive fluid balance and increased age were independently associated with mortality. Conclusions: Use of CRRT is prevalent among patients undergoing ECMO, with over

Concurrent Use of Renal Replacement Therapy during Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis

“…In total, 25 studies detailing 5896 adult patients that reported on the use of RRT and ECMO were included ( Table 1 ) [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Twenty-four studies were observational in nature [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], while one study was a randomised controlled trial (RCT) [ 52 ]. For our quantitative analysis, we included 24 observational studies (5855 patients), while the findings of the RCT were reported separately.…”

“…The pooled overall mortality ( Figure 1 ) in patients due to the use of RRT on ECMO (24 studies) was 62.9% (95% CI: 56.0–69.6%). Subgroup analysis found no significant differences ( p = 0.57) between in-hospital mortality (14 studies, 60.1%, 95% CI: 50.1–69.8%) [ 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 42 , 43 , 45 , 48 , 49 , 50 ], ICU mortality (3 studies, 67.3%, 95% CI: 60.1–74.1%) [ 28 , 29 , 32 ], 30-day mortality (3 studies, 68.4%, 95% CI: 58.0–77.9%) [ 41 , 44 , 47 ], and 90-day mortality (3 studies, 57.0%, 95% CI: 17.6–92.0%) [ 30 , 40 , 46 ]. Only one study mentioned overall mortality [ 51 ].…”

Extracorporeal membrane oxygenation combined with continuous renal replacement therapy for the treatment of severe burns: current status and challenges

“…Fluid overload is usually secondary to AKI or improper volume management during ECMO treatment. Research has shown that 40–60% of patients on ECMO who developed AKI were placed on CRRT [ 29 ]. Another study from the Extracorporeal Life Support Organization found that the indications for ECMO combined with CRRT include fluid overload (43%), AKI (35%), prevention of fluid overload (16%), electrolyte imbalances (4%) and other complications (2%) [ 30 ].…”

“…Another study from the Extracorporeal Life Support Organization found that the indications for ECMO combined with CRRT include fluid overload (43%), AKI (35%), prevention of fluid overload (16%), electrolyte imbalances (4%) and other complications (2%) [ 30 ]. Nevertheless, combined therapy was associated with increased mortality compared with ECMO alone, which ranged from 39.5% to 100% [ 29 , 31 , 32 ].…”

“…Dado et al. concluded that early integration of combined therapy with experience and expertise might contribute to improved outcomes [ 29 ].…”