Abstract
BackgroundThe introduction of a continuous renal replacement therapy (CRRT) device into the extracorporeal membrane oxygenation (ECMO) circuit is widely used. However, excessive pressure transmitted to the CRRT device is a major disadvantage. We investigated the effects of using additional pressure control lines on the pressure and the lifespan of the CRRT circuit connected to the ECMO.MethodsThis is an observational study using prospectively collected data from consecutive patients receiving CRRT connected into the ECMO circuit at a university-affiliated, tertiary hospital from January 2013 to December 2016. The CRRT circuit was connected into the ECMO circuit through the Luer Lock connection without an additional pressure control line in 16 patients (9%, no line group), an additional pressure control line on the inlet line in 36 patients (23%, single line group), and additional pressure control lines on both the inlet and outlet lines in 118 patients (77%, double line group). The outcome measures of interest were compared among the three groups.ResultsThe median access pressure was higher in the no line group compared to the groups. However, median filter pressure, effluent pressure, and return pressure were higher in the double line group compared to the other groups. There were no significant differences in platelets, lactate dehydrogenase, and plasma hemoglobin among the 3 groups over the time period studied. Median lifespan of the CRRT circuits in the double line group was 45.0 (29.0–63.7) hours, which was higher compared to 21.8 (11.6–31.8) hours in the no line group and 23.0 (15.0–34.6) hours in the single line group, respectively. In addition, in-hospital mortality was lower in the double line group (48.3%) compared to the no line group (68.8%) and the single line group (75.0%).ConclusionsAdditional tubing can be considered a simple and safe method for pressure control and lengthening circuit survival when connecting the CRRT device to the ECMO circuit.
Highlights
The introduction of a continuous renal replacement therapy (CRRT) device into the extracorporeal membrane oxygenation (ECMO) circuit is widely used
The objective of this study was to investigate the effects of using additional pressure control lines on the pressure and the lifespan of the CRRT circuit in adult patients receiving CRRT connected to the ECMO circuit
After excluding 261 patients who did not receive CRRT during ECMO support, we investigated 170 patients in whom the CRRT device was connected into the ECMO circuit (Fig. 1)
Summary
The introduction of a continuous renal replacement therapy (CRRT) device into the extracorporeal membrane oxygenation (ECMO) circuit is widely used. We investigated the effects of using additional pressure control lines on the pressure and the lifespan of the CRRT circuit connected to the ECMO. One of the major disadvantages of incorporating the CRRT device into the ECMO circuit is excessive positive or negative pressure transmitted to the CRRT device, resulting in unpredictable consequences [8]. Introducing additional tubing between the CRRT device and the ECMO circuit when connecting these two extracorporeal systems is a simple method to reduce blood flow between the systems and, control the excessive pressures [11]. The objective of this study was to investigate the effects of using additional pressure control lines on the pressure and the lifespan of the CRRT circuit in adult patients receiving CRRT connected to the ECMO circuit
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