Jessica Prucha, PharmD
Critical Care Clinical Pharmacist
University of Nebraska Medical Center
Omaha, NE
Disclosure information not submitted.
Gregory Peitz, PharmD, BCCCP, FCCM
Clinical Associate Professor and Critical Care Coordinator
Nebraska Medicine
Omaha, Nebraska, United States
Disclosure information not submitted.
Meghan Blais, BCCCP
Clinical Pharmacist, Adult Critical Care
Nebraska Medicine, United States
Disclosure information not submitted.
Title: Hemodynamic and ECMO Flow Response to Albumin versus Crystalloid Therapy
Introduction: Patients receiving Extracorporeal Membrane Oxygenation (ECMO) therapy are prone to hemodynamic disturbances from various causes including inadequate intravascular volume which may lead to ECMO low flow states. These flow states can result in a hypo-perfusion and ischemia. The Extracorporeal Life Support Organization (ELSO) guidelines do not specify which fluid to use to rectify low flow states, and the benefits of albumin versus crystalloid therapy are not well defined. This study evaluated if albumin administration has an advantage over crystalloid administration on fluid balance, ECMO flow rates, and hemodynamics in ECMO patients.
Methods: This was a retrospective study of adult patients treated with venovenous or venoarterial ECMO receiving crystalloid or albumin boluses for volume resuscitation between January 2019 and October 2020. Patients were assigned to an albumin-dense or crystalloid-dense resuscitation cohort, where an albumin-dense strategy was defined as the receipt of more than 10g albumin/1L fluid resuscitation. The primary outcome was change in overall fluid balance for the first 48 hours on ECMO. Outcomes were analyzed using Fishers exact and Mann-Whitney U tests for categorical and continuous data, respectively.
Results: A total of 51 patients were included with 42 in the albumin-dense cohort and 9 in the crystalloid-dense cohort. Median total fluid volume (liters) for the first 48 hours on ECMO was not statistically different between the albumin and crystalloid cohorts (0.95 vs. 1.25, p=0.81). Median fluid balance (liters) was higher for patients receiving albumin-dense resuscitation, but not statistically significant at 24 hours (2.5 vs. 1.1, p=0.21), 48 hours (0.56 vs. 0.29, p=0.70), or overall from 0-48 hours on ECMO (3.0 vs. 0.83, p=0.34). No significant differences were noted in ECMO flow rates, sweep speeds, SvO2, MAP, or HR. Additionally, there were no differences in median ICU length of stay (16 vs. 9, p=0.12) or mortality (36% vs. 44%, p=0.71) between the two cohorts.
Conclusion: This study suggests change in fluid balance for the first 48 hours on ECMO was not impacted by fluid resuscitation strategy, and there were no noted benefits of colloid versus crystalloid administration on hemodynamic or ECMO fluid response.