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Author Notes:

Correspondence: Dr. David J. Askenazi, Division of Pediatric Nephrology, University of Alabama at Birmingham, 1600 7th Avenue South, ACC 516, Birmingham, AL 35233. daskenazi@peds.uab.edu

We thank all of the nurses, perfusionists, and ECMO specialists at our institutions who provide an infrastructure and excellent care for these very vulnerable patients.

D.J.A. is a consultant and is on the speaker’s bureau for Gambro.

M.L.P. has several patents pending on a pediatric CRRT device that can be used with ECMO.

Subjects:

Research Funding:

G.M.F. received funding from the ELSO registry to study RRT use in ECMO patients.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Urology & Nephrology
  • UROLOGY & NEPHROLOGY
  • ACUTE KIDNEY INJURY
  • ACUTE LUNG INJURY
  • CONTINUOUS VENOVENOUS HEMOFILTRATION
  • STEM-CELL TRANSPLANTATION
  • FLUID OVERLOAD
  • RESPIRATORY-FAILURE
  • LIFE-SUPPORT
  • PEDIATRIC-PATIENTS
  • CHILDREN
  • HEMOLYSIS

Renal Replacement Therapy in Critically Ill Patients Receiving Extracorporeal Membrane Oxygenation

Tools:

Journal Title:

Clinical Journal of the American Society of Nephrology

Volume:

Volume 7, Number 8

Publisher:

, Pages 1328-1336

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure used in neonates, children, and adults with severe, reversible, cardiopulmonary failure.On the basis of single-center studies, the incidence of AKI occurs in 70%-85% of ECMO patients. Those with AKI and those who require renal replacement therapy (RRT) are at high risk for mortality, independent of potentially confounding variables. Fluid overload is common in ECMO patients, and is one of the main indications for RRT. RRT to maintain fluid balance and metabolic control is common in some but not all centers. RRT on ECMO can be performed via an in-line hemofilter or by incorporating a standard continuous renal replacement machine into the ECMO circuit. Both of these methods require specific technical considerations to provide safe and effective RRT. This reviewsummarizes available epidemiologic data and how they apply to our understanding of AKI pathophysiology during ECMO, identifies indications for RRT while on ECMO, reviews technical elements for RRT application in the setting of ECMO, and finally identifies specific researchfocused questions that need to be addressed to improve outcomes in this at-risk population.

Copyright information:

Copyright © 2012 by the American Society of Nephrology

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