Adjunct Use of Continuous Renal Replacement Therapy with Extracorporeal Membrane Oxygenation Achieves Negative Fluid Balance and Enhances Oxygenation Which Improves Survival in Critically Ill Patients without Kidney Failure

Jason M. Thomas, David N. Dado*, Anthony P. Basel, James K. Aden, Sarah B. Thomas, Lydia Piper, Garrett W. Britton, Leopoldo C. Cancio, Andriy Batchinsky, Phillip E. Mason, Robert Walter, Michal J. Sobieszczyk, Mauer Biscotti, T. Jake Lee, Matthew D. Read, Valerie G. Sams

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Introduction: Fluid overload in extracorporeal membrane oxygenation (ECMO) patients has been associated with increased mortality. Patients receiving ECMO and continuous renal replacement therapy (CRRT) who achieve a negative fluid balance have improved survival. Limited data exist on the use of CRRT solely for fluid management in ECMO patients. Methods: We performed a single-center retrospective review of 19 adult ECMO patients without significant renal dysfunction who received CRRT for fluid management. These patients were compared to a cohort of propensity-matched controls. Results: After 72 h, the treatment group had a fluid balance of -3840 mL versus + 425 mL (p ≤ 0.05). This lower fluid balance correlated with survival to discharge (odds ratio 2.54, 95% confidence interval 1.10-5.87). Improvement in the ratio of arterial oxygen content to fraction of inspired oxygen was also significantly higher in the CRRT group (102.4 vs. 0.7, p ≤ 0.05). We did not observe any significant difference in renal outcomes. Conclusions: The use of CRRT for fluid management is effective and, when resulting in negative fluid balance, improves survival in adult ECMO patients without significant renal dysfunction.

Original languageEnglish
Pages (from-to)477-484
Number of pages8
JournalBlood Purification
Volume51
Issue number6
DOIs
StatePublished - 1 Jun 2022

Keywords

  • Continuous renal replacement therapy
  • Extracorporeal membrane oxygenation
  • Fluid management
  • Renal replacement therapy

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