074 PATIENT SAFETY EVALUATION FOR COMBINING CONTINUOUS RENAL REPLACEMENT THERAPY WITH EXTRACORPOREAL MEMBRANE OXYGENATION

Abstract

Category: RRT Technique Characteristics Presenter: Mr PETER CHI KEUNG LAI Keywords: Continuous Renal Replacement Therapy, Extracorporeal Membrane Oxygenation, Patient Safety Connecting Continuous Renal Replacement Therapy (CRRT) in parallel with Extracorporeal Membrane Oxygenation (ECMO) is a common practice. However, this technique may potentially lead to complications such as hemolysis, circuit clotting and membrane oxygenator malfunction. To evaluate safety issues related to combining CRRT with ECMO circuit. Retrospective chart review of adult ECMO patients with concomitant CRRT in a university-affiliated hospital in 2015 - 2016. 27 patients received CRRT through ECMO circuitry. 12 received veno-venous ECMO and 15 received veno-arterial ECMO. 4 cases received CRRT with regional citrate anticoagulation, while others received intravenous unfractionated heparin infusion as per ECMO protocol. When patients were stratified for data analysis by ECMO blood flow rate: low flow (LF; <3.0lpm), normal flow (NF; >3 - 4lpm) and high flow (HF; >4lpm), there was no significant between-group difference on patient demographics, survival rate, reasons for ECMO initiation, baseline renal function and fluid balance and CRRT efficacy. ICU length of stay was significantly lower in LF group, indicating less severity of illness (LF vs NF, 3.8 vs 18.3, p 0.02; LF vs HF, 3.8 vs 28.6, p 0.01). CRRT treatment hours (p 0.03) and haemofilter use (p 0.01) was also less in LF group than in HF group. Mean CRRT pressures for inlet, outlet, transmembrane pressure and pressure drop were 123.19mmHg, 215.74mmHg, 86.15mmHg and 37.70mmHg respectively. CRRT return pressure was higher in HF group (p 0.03) than LF group, with peak pressure reaching 343mmHg in one case. Yet, there was no haemolysis nor haemorrhagic event was reported in the study period. CRRT can be effectively incorporated into ECMO circuitry without jeopardizing ECMO treatment and patient safety. Consideration should be taken to monitor CRRT circuit pressures when a higher ECMO blood flow is being used.