Outcomes associated with the use of renal replacement therapy in children receiving extracorporeal membrane oxygenation after heart surgery: a multi-institutional analysis

Gupta, Punkaj; Beam, Brandon; Schmitz, Michael L.

doi:10.1007/s00467-014-3025-y

Cited by 13 publications

(19 citation statements)

References 18 publications

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“…2,5,6,9,[11][12][13]15,16 Mortality rate in this study (49%) is similar to that reported in other studies. 4,6,7,9,12,13,15,16 An important finding of this study is that severe AKI (stages II and III) was associated with higher mortality, which is consistent with the findings reported by different authors. 2,5,6,9,[11][12][13]15,16 Our data also show that children treated with CRRT had a significantly higher mortality rate than those without CRRT, as reported in other studies.…”

Section: Evolution Of Renal Function After Ecmosupporting

confidence: 88%

“…Some studies show that CRRT is associated with worsen AKI, 5,7,10,[13][14][15] whereas others show that renal function improves with CRRT. 2,3 It is difficult to argue for and against this, as urine output usually decreases after starting CRRT, and creatinine levels can be no longer considered as a marker of renal function but as a marker of proper performance of the technique.…”

Section: Renal Replacement Therapiesmentioning

confidence: 99%

“…2,3,5,7,8,10,12,14 The advantages of early CRRT are a better fluid and electrolyte balance and the instauration of appropriate nutrition. 3,7,9,12,14,15 On the contrary, patients on ECMO plus CRRT have a greater need for transfusions, longer ECMO duration, and longer pediatric intensive care unit (PICU) length of stay. 3,5,7,[9][10][11] The association between the modality of CRRT and mortality 3,7,11 or chronic renal failure 7,9,10 has not been studied.…”

Section: Introductionmentioning

confidence: 99%

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Renal function in children assisted with extracorporeal membrane oxygenation

et al. 2019

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Acute kidney injury is a frequent complication in patients requiring extracorporeal membrane oxygenation. A single-center retrospective analysis from a prospective observational database assessing the incidence of acute kidney injury in children undergoing extracorporeal membrane oxygenation, the use of continuous renal replacement therapy and its association with outcomes was performed. One hundred children were studied. Creatinine was normal in 33.3% of children at the beginning of extracorporeal membrane oxygenation, between 1.5 and 2 times its baseline levels in 18.4% of children (stage I acute kidney injury), between 2 and 3 times baseline levels (stage II) in 20.7%, and over 3 times baseline levels or requiring continuous renal replacement therapy (stage III) in 27.6% of the patients. Eighteen patients were on continuous renal replacement therapy before the beginning of extracorporeal membrane oxygenation, 81 required continuous renal replacement therapy during extracorporeal membrane oxygenation, and 38 after weaning from extracorporeal membrane oxygenation, but none of them did at discharge from the pediatric intensive care unit. Fifty-one children survived to pediatric intensive care unit discharge. Mortality was lower in children with normal kidney function or with stage I acute kidney injury at the beginning of extracorporeal membrane oxygenation than in those with stage II or III acute kidney injury (33.3% vs 58.3%, p = 0.021). Mortality in children requiring continuous renal replacement therapy during extracorporeal membrane oxygenation was 54.3% and 21.1% in the rest of patients (p < 0.01). We conclude that kidney function is significantly impaired in a high percentage of children undergoing extracorporeal membrane oxygenation and many of them are treated with continuous renal replacement therapy. Patients treated with continuous renal replacement therapy have a higher mortality than those with normal kidney function or stage I acute kidney injury at the beginning of extracorporeal membrane oxygenation. Most patients surviving to pediatric intensive care unit discharge recover normal renal function after weaning from extracorporeal membrane oxygenation.

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Section: Evolution Of Renal Function After Ecmosupporting

confidence: 88%

Section: Renal Replacement Therapiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Renal function in children assisted with extracorporeal membrane oxygenation

et al. 2019

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“…Renal insufficiency at the time of IHCA may affect the decision to initiate or withhold mechanical support for these patients, especially in light of recent reports demonstrating worse outcomes for neonates and children with acute kidney injury requiring ECMO. 62–64 …”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Cardiopulmonary Resuscitation (E-CPR) During Pediatric In-Hospital Cardiopulmonary Arrest Is Associated With Improved Survival to Discharge

et al. 2016

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Background Although extracorporeal CPR (E-CPR) can result in survival after failed conventional CPR (C-CPR), no large, systematic comparison of pediatric E-CPR versus continued C-CPR has been reported. Methods and Results Consecutive patients <18 years old with CPR events ≥ 10 minutes duration reported to GWTG-R between January 2000 and December 2011 were identified. Hospitals were grouped by teaching status and location. Primary outcome was survival to discharge. Regression modeling was performed conditioning on hospital groups. A secondary analysis was performed using propensity-score matching. Of 3,756 evaluable patients, 591 (16%) received E-CPR and 3,165 (84%) received C-CPR only. Survival to hospital discharge and survival with favorable neurologic outcome (Pediatric Cerebral Performance Category score of 1–3 or unchanged from admission) were greater for E-CPR [40% (237/591) and 27% (133/496)] versus C-CPR patients [27% (862/3,165) and 18% (512/2,840)]. Odds ratios for survival to hospital discharge and survival with favorable neurologic outcome were greater for E-CPR versus C-CPR. After adjusting for covariates, patients receiving E-CPR had higher odds of survival to discharge [OR 2.80, 95% CI 2.13–3.69, p <0.001] and survival with favorable neurologic outcome [OR 2.64, 95% CI 1.91–3.64, p < 0.001] than patient who received C-CPR. This association persisted when analyzed by propensity-score matched cohorts [OR 1.70, 95% CI 1.33–2.18, p < 0.001 and OR 1.78, 95% CI 1.31–2.41, p < 0.001 respectively]. Conclusions For children with in-hospital CPR ≥ 10 minutes duration, E-CPR was associated with improved survival to hospital discharge and survival with favorable neurologic outcome when compared to C-CPR.

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“…Patients with respiratory syncytial virus infection, aspiration pneumonia, and near-fatal asthma [47] has better chances to survive while those with ARDS related to sepsis, pertussis, fungal pneumonia, disseminated herpes simplex virus infection, immunodeficiency, multiorgan failure, and longer duration of mechanical ventilation (>14 days) before ECLS deployment have higher odds of mortality [12,23,43,44,[47][48][49][50][51][52][53]. Pre-ECLS severe acidosis in addition to renal failure and need for continuous renal replacement therapy (CRRT) have been related to lower survival, longer ECLS duration, and higher complication rate [54,55].…”

Section: Pediatric Ecls (>30 Days To <18 Years)mentioning

confidence: 99%

Extracorporeal Life Support: Four Decades and Counting

Alibrahim

Heard

2017

Curr Anesthesiol Rep

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Extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) is a form of heart lung bypass that is used to support neonates, pediatrics, and adult patients with cardiorespiratory failure for days or weeks till organ recovery or transplantation. Venoarterial (VA) and venovenous (VV) ECLS are the most common modes of support. ECLS circuit components and monitoring have been evolving over the last 40 years. The technology is safer, simpler, and more durable with fewer complications. The use of neonatal respiratory ECLS use has been declining over the last two decades, while adult respiratory ECLS is growing especially since the H1N1 influenza pandemic in 2009. This review provides an overview of ECLS evolution over the last four decades, its use in neonatal, pediatric and adults, description of basic principles, circuit components, complications, and outcomes as well as a quick look into the future.

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Outcomes associated with the use of renal replacement therapy in children receiving extracorporeal membrane oxygenation after heart surgery: a multi-institutional analysis

Cited by 13 publications

References 18 publications

Renal function in children assisted with extracorporeal membrane oxygenation

Renal function in children assisted with extracorporeal membrane oxygenation

Extracorporeal Cardiopulmonary Resuscitation (E-CPR) During Pediatric In-Hospital Cardiopulmonary Arrest Is Associated With Improved Survival to Discharge

Extracorporeal Life Support: Four Decades and Counting

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