Review of acute kidney injury and continuous renal replacement therapy in pediatric extracorporeal membrane oxygenation
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REVIEW ARTICLE
Review of acute kidney injury and continuous renal replacement therapy in pediatric extracorporeal membrane oxygenation Christopher Jenks 1
&
Lakshmi Raman 2,3 & Archana Dhar 2,3
Received: 29 July 2020 / Revised: 25 September 2020 / Accepted: 29 September 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Purpose To review the relevant literature of acute kidney injury (AKI) and continuous renal replacement therapy (CRRT) as it relates to pediatric extracorporeal membrane oxygenation (ECMO). Methods Available online relevant literature. Results ECMO is a therapeutic modality utilized to support patients with refractory respiratory and/or cardiac failure. AKI and fluid overload (FO) are frequently observed in this patient population. There are multiple modalities that can be utilized for AKI and FO which include the following: diuretics, in-line hemofiltration, and CRRT. There are multiple considerations when using CRRT with ECMO including access, CRRT flows, hemolysis, anticoagulation, and CRRT termination. Conclusion While each ECMO center has its own set of equipment, experiences, and practices, it is imperative that the international ECMO community continues to work together to provide an evidence-based approach to address the morbidity and mortality associated with AKI and FO. Keywords CRRT . ECMO . ECLS . Fluid overload . AKI
Background Extracorporeal membrane oxygenation (ECMO) is a therapeutic modality utilized to support patients with refractory respiratory and/or cardiac failure. Originally, ECMO was predominantly used in neonates and pediatric patients, but since the novel influenza A subtype H1N1 (also known as the swine flu) pandemic of 2009, there has been an exponential growth in adult ECMO [1]. In addition, increasingly sick, complex patients with multiorgan system failure are being placed onto ECMO support [2–6]. ECMO is a modified heart-lung machine. This machine was first successfully used for heart surgery by Dr. Gibbon
* Christopher Jenks [email protected] 1
Blair E Batson Children’s Hospital, Department of Pediatrics, Section of Critical Care, University of Mississippi Medical Center, Jackson, MS, USA
2
Children’s of Dallas, Department of Pediatrics, Section of Critical Care, University of Texas Southwestern Medical Center, Dallas, TX, USA
3
Children’s Health, Dallas, TX, USA
in 1953, and in 1968 was adapted for use in adults outside of the operating room with limited success. ECMO emerged as a therapeutic modality in the neonatal population after its use in a neonate with meconium aspiration by Dr. Bartlett in 1975. The use of ECMO has been exponentially increasing over the last decade and is now considered a mainstream life-saving treatment modality in critical care medicine [7]. Continuous renal replacement therapy (CRRT) is a routinely used tool today in critically ill patients to support the kidneys. The development of this modality for dialysis and its growth has paralleled that of ECMO. In 1977, Kramer was placing a central line for dialy
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