Continuous renal replacement therapy in patients treated with extracorporeal membrane oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy utilized for patients with severe life-threatening cardiorespiratory failure. Patients treated with ECMO are among the most severely ill encountered in critical care and are at high-risk of developing multiple organ dysfunction, including acute kidney injury (AKI) and fluid overload. Continuous renal replacement therapy (CRRT) is increasingly utilized inpatients on ECMO to manage AKI and treat fluid overload. The indications for renal replacement therapy for patients on ECMO are similar to those of other critically ill populations; however, there is wide practice variation in how renal supportive therapies are utilized during ECMO. For patients requiring both CRRT and ECMO, CRRT may be connected directly to the ECMO circuit, or CRRT and ECMO may be performed independently. This review will summarize current knowledge of the epidemiology of AKI, indications and timing of CRRT, delivery of CRRT, and the outcomes of patients requiring CRRT with ECMO.

FIGURE 1

Inline Hemofilter combined with ECMO. The inflow to the hemofilter is typically distal to the blood pump, either between the pump and oxygenator or distal to the oxygenator. The outflow from the hemofilter typically returns prior to the blood pump, but can also return prior to the oxygenator

FIGURE 2

CRRT combined with ECMO. In this example, the inflow to the CRRT machine is distal to the oxygenator, and the outflow from the CRRT machine returns to the ECMO circuit proximal to the blood pump

FIGURE 3

CRRT combined with ECMO. In this example, the inflow to the CRRT machine is between the blood pump and the oxygenator, and the outflow from the CRRT machine returns to the ECMO circuit proximal to the blood pump

FIGURE 4

CRRT combined with ECMO. In this example, both the inflow to and outflow from the CRRT machine are connected proximal to the blood pump