Abstract
IntroductionExtracorporeal membrane oxygenation is a supportive cardiopulmonary bypass technique for patients with acute reversible cardiovascular or respiratory failure. Favourable effects of haemofiltration during cardiopulmonary bypass instigated the use of this technique in infants on extracorporeal membrane oxygenation. The current study aimed at comparing clinical outcomes of newborns on extracorporeal membrane oxygenation with and without continuous haemofiltration.MethodsDemographic data of newborns treated with haemofiltration during extracorporeal membrane oxygenation were compared with those of patients treated without haemofiltration in a retrospective 1:3 case-comparison study. Primary outcome parameters were time on extracorporeal membrane oxygenation, time until extubation after decannulation, mortality and potential cost reduction. Secondary outcome parameters were total and mean fluid balance, urine output in mL/kg/day, dose of vasopressors, blood products and fluid bolus infusions, serum creatinin, urea and albumin levels.ResultsFifteen patients with haemofiltration (HF group) were compared with 46 patients without haemofiltration (control group). Time on extracorporeal membrane oxygenation was significantly shorter in the HF group: 98 hours (interquartile range (IQR) = 48 to 187 hours) versus 126 hours (IQR = 24 to 403 hours) in the control group (P = 0.02). Time from decannulation until extubation was shorter as well: 2.5 days (IQR = 0 to 6.4 days) versus 4.8 days (IQR = 0 to 121.5 days; P = 0.04). The calculated cost reduction was €5000 per extracorporeal membrane oxygenation run. There were no significant differences in mortality. Patients in the HF group needed fewer blood transfusions: 0.9 mL/kg/day (IQR = 0.2 to 2.7 mL/kg/day) versus 1.8 mL/kg/day (IQR = 0.8 to 2.9 mL/kg/day) in the control group (P< 0.001). Consequently the number of blood units used was significantly lower in the HF group (P< 0.001). There was no significant difference in inotropic support or other fluid resuscitation.ConclusionsAdding continuous haemofiltration to the extracorporeal membrane oxygenation circuit in newborns improves outcome by significantly reducing time on extracorporeal membrane oxygenation and on mechanical ventilation, because of better fluid management and a possible reduction of capillary leakage syndrome. Fewer blood transfusions are needed. All in all, overall costs per extracorporeal membrane oxygenation run will be lower.
Highlights
Extracorporeal membrane oxygenation is a supportive cardiopulmonary bypass technique for patients with acute reversible cardiovascular or respiratory failure
Pediatric Logistic Organ Dysfunction (PELOD), Oxygenation Index (OI) and Alveolar-arterial Oxygen Gradient (AaDO2) scores were taken within six hours of cannulation
There are more patients with congenital diaphragmatic hernia (CDH) in the control group there are no significant differences in Pediatric Risk of Mortality Scores (PRISM), PELOD, OI and AaDO2 scores reflecting a similar severity of illness before Extracorporeal membrane oxygenation (ECMO)
Summary
Extracorporeal membrane oxygenation is a supportive cardiopulmonary bypass technique for patients with acute reversible cardiovascular or respiratory failure. Extracorporeal membrane oxygenation (ECMO) is a supportive cardiopulmonary bypass (CPB) technique for patients with acute reversible cardiovascular or respiratory failure. AaDO2: alveolar-arterial oxygen tension gradient; CDH: congenital diaphragmatic hernia; CPB: cardiopulmonary bypass; CVVH: continuous venovenous haemofiltration; ECMO: extracorporeal membrane oxygenation; ICU: intensive care unit; IQR: interquartile range; OI: Oxygenation Index; PELOD: pediatric logistic organ dysfunction; PRISM: Pediatric Risk of Mortality Score; SIRS: systemic inflammatory response syndrome. The ECMO system activates leucocytes, thrombocytes and the complement system [3,4] This leads to water and small molecule leakage through the capillary membrane, and to leakage of relatively large molecules, including albumin. Low blood pressure and tissue oedema will potentially cause deficient tissue perfusion and oxygenation leading to multi-organ failure, of which lung and kidney failure are most prominent
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