Impact of an inline extracorporeal membrane oxygenation hemofilter system in neonatal acute kidney injury

Figures & data

Figure 1 Pictures of chest radiographs during ECMO therapy.

Note: (A) Two hours post ECMO and (B) 6 days post ECMO.
Abbreviation: ECMO, extracorporeal membrane oxygenation.

Figure 2 ECMO circuit with an inline hemofilter system.

Abbreviation: ECMO, extracorporeal membrane oxygenation.

Table 1 Fluid, ECMO, and ventilation parameters

	Day 2	Day 4	Day 6	Day 8
Fluid parameters
Urine output (mL/kg/hour)	0.1	0.2	0.9	1.1
Ultrafiltration (mL/day)	686	420	322	280
Fluid balance (mL/day)	−320 mL	−180 mL	−460 mL	−310 mL
Ventilation parameters
Ventilator mode	SIMV-PC	SIMV-PC	SIMV-PC	SIMV-PC
Peak inspiratory pressure (cmH2O)	23	22	21	18
Positive end expiratory pressure (cmH2O)	8	7	6	5
Inspired oxygen fraction (%)	50	40	35	30
Arterial blood gases
pH	7.39	7.41	7.43	7.46
Oxygen tension (mmHg)	120	160	180	195
Carbon dioxide tension (mmHg)	47.2	43	45	37
Oxygen saturation (%)	91	93	92	95
ECMO parameters
ECMO flow/LPM	0.5	0.5	0.4	0.3
Gas LPM	0.4	0.2	0.2	0.2
Hemofilter	No clotting	No clotting	No clotting	No clotting
Line pressure (mmHg)	189	175	185	190
ACT (seconds)	190	210	185	200

Abbreviations: ECMO, extracorporeal membrane oxygenation; LPM, liters per minute; ACT, activated clotting time; SIMV, synchronized intermittent mandatory ventilation; PC, pressure control.

Table 2 Lab monitoring on pre- and postoperative days

Parameters	Preop day	Postoperative day
		Day 0	Day 1	Day 2	Day 3	Day 4	Day 5	Day 6
Hb (g/dL)	9.3	10.2	10.3	9.6	9.8	10.1	9.4	10.4
WBC (×10^9/L)	6.5	5.5	7.2	6.6	8.8	7.9	6.7	5.6
Platelets (×10^9/L)	222	165	166	186	192	222	242	222
Sodium (mmol/L)	138	135	137	138	137	136	134	139
Potassium (mmol/L)	4.9	6.1	4.3	3.4	3.8	3.9	3.3	3.2
Bicarbonate (mmol/L)	22	16	15	17	18	20	22	23
Blood urea nitrogen (mg/dL)	7.84	42	30.8	29.4	27.4	26.8	25.7	23.8
Creatinine (mg/dL)	0.452	1.470	1.08	0.99	0.859	0.83	0.803	0.81
LDH (U/L)	233		263	222	–	–	265	–
Calcium (mmol/L)	2.4	2.3	2.5	2.25	2.56	2.46	2.47	2.3
Phosphate (mmol/L)	1.8	1.5	1.4	1.65	1.2	1.4	1.1	1.3
Uric acid (µmol/L)	220	469	210	215	202	196	186	188
Lactate (mmol/L)	5.2	13.6	11.2	8.2	5.3	3.6	2.1	1.8
AST/ALT (U/L)	12/14	16/18	19/22	17/25	15/22	14/23	17/22	19/26

Abbreviations: preop, preoperative; Hb, hemoglobin; WBC, white blood cell count; LDH, lactate dehydrogenase; AST, aspartate aminotransferase; ALT, alanine aminotransferase.