079 OUTCOMES EVALUATION OF PATIENTS ON EXTRACORPOREAL MEMBRANE OXYGENATION WITH CONCOMITANT CONTINUOUS RENAL REPLACEMENT THERAPY

Abstract

Category: RRT Applications and Targeted Interventions Presenter: Mr PETER CHI KEUNG LAI Keywords: Extracorporeal Membrane Oxygenation, Concomitant Continuous Renal Replacement Therapy Patients on Extracorporeal Membrane Oxygenation (ECMO) often have acute kidney injury or fluid overload requiring Continuous Renal Replacement Therapy (CRRT). There was evidence that ECMO patient requiring CRRT had higher mortality due to increased severity of illness, but it is uncertain how CRRT affects outcomes of ECMO patients. To explore the characteristics of ECMO survivors who underwent concomitant CRRT. Retrospective chart review of 27 adult ECMO patients with CRRT in a university-affiliated hospital in 2015 - 2016. 12 patients had veno-venous ECMO and 15 had veno-arterial ECMO. Indications for ECMO were hypoxemic respiratory failure refractory to conventional therapy, cardiogenic shock associated with myocardial infarction, myocarditis and cardiac arrest. Mean age was 49.4±14.8 years. 9 ECMO-CRRT patients survived and 18 died. There were more patients with primary respiratory diseases in survivor group (77.8% vs 17.8%, p=0.01). Similar findings were observed between survivors and non-survivors for ECMO blood flow rate (3.96±0.56 vs 3.5±0.6, p=0.06), ECMO duration (16.7±14.1 vs 13.8±16.1, p=0.64) and length of stay in intensive care unit (ICU) (29.3±25.6 vs 15.0±17.0, p=0.16). CRRT-ECMO configuration was the same for all cases, except for one case in which CRRT was conducted with non-tunneled dialysis catheter. Indications for CRRT treatment included acute kidney injury, fluid overload and metabolic disturbance. 23 patients received systemic ECMO anticoagulation with unfractionated heparin infusion at 12-18unit/kg/hour while 4 patients in non-survivor group received regional citrate anticoagulation for CRRT. Baseline creatinine before CRRT was 327.7±233.9umol/L and percentage creatinine change was 41.4±21.2%. CRRT treatment hours (151.6±191.1 hours), total fluid removal with CRRT (12.9±18.1 liters) and number of hemofilter change (5.0±4.6) were not associated to increase in mortality. In this series of 27 patients managed with ECMO and concomitant CRRT in an adult ICU, survival to ICU discharge was 33.3%. Mortality risk was increased in patients with circulatory failure but not it was not associated with CRRT treatment modality.