Combination of Continuous Renal Replacement Therapies (CRRT) and Extracorporeal Membrane Oxygenation (ECMO) for Advanced Cardiac Patients

Figures & data

Figure 1. Combination of continuous renal replacement therapies (CRRT) and extracorporeal membrane oxygenation (ECMO) circuit. Drainage is accomplished from the femoral vein, whereas arterial access is gained through the femoral arteries. Continuous renal replacement therapy is incorporated in the ECMO circuit. Arterial drainage of CRRT is coming out before BioPump, passes through the CRRT dialyzer, and goes back to ECMO circuit post-BioPump and before oxygenator. Abbreviation: A = arterial; V = venous.

Table 1. Causes of advanced heart failure

Causes	Number
Myocarditis	5
Post-cardiotomy cardiogenic shock	4
Primary graft failure post heart transplantation	1

Table 2. Differences between survivor and non-survivor in advanced heart failure patients on ECMO

	Survivor	Non-survivor	p-Value
Gender (M:F)	1:3	4:2	0.524
Age (years)	37.00 ± 14.54	46.17 ± 7.41	0.394
APACHE II	19.00 ± 9.38	24.67 ± 3.50	0.392
ECMO duration (h)	52.50 ± 30.48	114.42 ± 133.36	0.286
OSF	2.75 ± 0.50	4.33 ± 0.52	0.007<0.05
ARF with CRRT (n)	0	5	0.048<0.05

Abbrieviations: M = male; F = female; ECMO = extracorporeal membrane oxygenation; OSF = organ system failure; ARF = acute renal failure; CRRT = continuous renal replacement therapies.

Table 3. Criteria for organ system failure

Organ system	Criteria
Neurological	Glasgow coma scale ≤6 (in absence of sedation at any one point in day)
Cardiovascular	Mean arterial pressure ≤55 mmHg
	Heart rate ≤50 beats/min
	Need for volume loading and/or vasoactive drugs to maintain systolic blood pressure above 100 mmHg
	Occurrence of ventricular tachycardia/fibrillation
	Cardiac arrest
	Acute myocardial infarction
Pulmonary	Respiratory rate ≤5/min or ≥50/min
	Mechanical ventilation for three or more days
	Fraction of inspired oxygen (FiO2)>0.4 and/or postitive end-expiratory pressure >5 cmH2O
Gastrointestinal	Stress ulcer necessitating transfusion of more than 2 units of blood per 24 h
	Hemorrhagic Pancreatitis
	Acalculous cholecystitis
	Necrotizing enterocolitis
	Bowel perforation
Hepatic	Clinical jaundice or total bilirubin level ≥3 mg/dL in the absence of hemolysis
	Serum glutamic-pyruvic transaminase ≥twice normal
	Hepatic encephalopathy
Hematological	Hematocrit ≤20%
	Leukocyte count ≤0.3 × 10^9/L
	Thrombocyte count ≤50 × 10^9/L
	Disseminated intravascular coagulation

Figure 2. Mean creatinine level (Cr) between acute renal failure (ARF) and non-acute renal failure (Non-ARF).

Figure 3. Mean daily urine output between acute renal failure (ARF) and non-acute renal failure (Non-ARF).