Impact of CRRT in Patients with PARDS Treated with VV-ECMO.

Sébastien Redant,Ashita Tolwani,Fabio S Taccone,Patrick M Honoré,Océane Barbance,Dominique Biarent,Xavier Beretta-Piccoli,David De Bels,Jacques Massaut

doi:10.3390/membranes11030195

Abstract

The high mortality of pediatric acute respiratory distress syndrome (PARDS) is partly related to fluid overload. Extracorporeal membrane oxygenation (ECMO) is used to treat pediatric patients with severe PARDS, but can result in acute kidney injury (AKI) and worsening fluid overload. The objective of this study was to determine whether the addition of CRRT to ECMO in patients with PARDS is associated with increased mortality. Methods: We conducted a retrospective 7-year study of patients with PARDS requiring ECMO and divided them into those requiring CRRT and those not requiring CRRT. We calculated severity of illness scores, the amount of blood products administered to both groups, and determined the impact of CRRT on mortality and morbidity. Results: We found no significant difference in severity of illness scores except the vasoactive inotropic score (VIS, 45 ± 71 vs. 139 ± 251, p = 0.042), which was significantly elevated during the initiation and the first three days of ECMO. CRRT was associated with an increase in the use of blood products and noradrenaline (p < 0.01) without changing ECMO duration, length of PICU stay or mortality. Conclusion: The addition of CRRT to ECMO is associated with a greater consumption of blood products but no increase in mortality.

Highlights

Pediatric acute respiratory distress syndrome (PARDS) is a rare condition with an incidence that varies from 2.0 to 12.8 per 100,000 children per year [1], representing approximately 3% of patients admitted to the pediatric intensive care unit (PICU) [2]
The primary objective of this study was to investigate whether the addition of CRRT to Extracorporeal membrane oxygenation (ECMO) in pediatric acute respiratory distress syndrome (PARDS) patients is associated with increased mortality
The secondary objectives were to determine the impact of the addition of CRRT on the use of blood products and the duration of ECMO, mechanical ventilation and PICU stay

Summary

Introduction

Pediatric acute respiratory distress syndrome (PARDS) is a rare condition with an incidence that varies from 2.0 to 12.8 per 100,000 children (aged 0 to 15 years) per year [1], representing approximately 3% of patients admitted to the pediatric intensive care unit (PICU) [2]. ECMO can lead to worsening fluid overload as a result of resuscitation maneuvers and/or acute kidney injury (AKI), which delays or prevents the restoration of euvolemia (Figure 1). Doses of diuretics up to 2 mg/kg/h in addition to fluid restriction (Figure 1). The use of CRRT with ECMO has been shown to not increase the risk of mortality in adults [22]; its use in pediatric patients remains controversial, especially in pediatric resuscitation. The primary objective of this study was to investigate whether the addition of CRRT to ECMO in PARDS patients is associated with increased mortality. The secondary objectives were to determine the impact of the addition of CRRT on the use of blood products and the duration of ECMO, mechanical ventilation and PICU stay

Objectives

Methods

Discussion

Conclusion