Continuous hemofiltration in a single circuit with extracorporeal membrane oxygenation in children with critical heart failure after cardiac surgery
Abstract
The development of acute kidney injury (AKI) in patients requiring extracorporeal membrane oxygenation (ECMO) is a consequence of severe critical condition, hypoxia and hypoperfusion of organs
and tissues. To replace kidney function during ECMO is a continuous method of renal replacement
therapy (CRRT) often used in clinical practice.
Aim. То determine the general guidelines of concept, safety and efficacy of the combined CRRT and
ECMO.
Material and methods. The study lasted from January 2010 to January 2017 enrolled 86 children undergone open heart surgeries and requiring artificial circulatory support (ECMO) combined with CRRT. The age of patients ranged from 6 days to 14 years. The extracorporeal system
of ECMO was connected with the independent circuit (without machine support) for the RRT by
continuous hemofiltration (HF). Anticoagulation was performed with non-fractionated heparin;
activated clotting time was maintained within 180–200 seconds. Use of control devices on a replacement and an ultrafiltration lines is a precondition for the efficient and accurate compliance of
the fluid balance during concomitant procedures.
Results. The main therapeutic target in these patients is to restore water and electrolyte balance. The correctness of the selected HF protocol was confirmed by reduction and normalization
of CVP and Pla levels. During the first HF day we noted a significant decrease in potassium level
from 5.7 (5.25–6.45) to 4.85 (4.625–5.175) mmol/l, p<0.05. Substitute solutions with a sodium
concentration of 140 mmol/L allowed maintaining its blood levels. The effectiveness of conducting
combined extracorporeal intensive care contributed to the correction of severe metabolic disorders
(lactataemia, acidosis). Slow dynamics of azotemia was due to the high catabolism level in children
with MODS and the absence of a diffusion component in the ongoing HF.
Conclusions. Considering the need of monitoring the electrolyte, acid-base and water balance
in patients with AKI a continuous HF as a method of renal function support can be recommended in
conjunction with ECMO at a critical cardiac and respiratory failure.
Keywords:extracorporeal membrane oxygenation, hemofiltration
Clin. Experiment. Surg. Petrovsky J. 2017; 5 (1): 59–67.
DOI: 10.24411/2308-1198-2017-00022
Received: 14.11.2016. Accepted: 10.02.2017.
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