Michael Kouch
Intensivist and Assistant Professor Of Medicine
n/a
Disclosure information not submitted.
Meghan Gorski, MD
Critical Care Fellow
Cooper University Health Care, United States
Disclosure information not submitted.
Solomon Dawson, MD
Assistant Professor of Medicine, Division of Nephrology
Cooper University Health Care, United States
Disclosure information not submitted.
Nitin Puri, MD
Director, Center for Critical Care Services
Cooper University Health Care
Camden, NJ
Disclosure information not submitted.
Title: A Comparison of Venous Access Configuration for Continuous Renal Replacement Therapy in VV ECMO
Introduction: Continuous renal replacement therapy (CRRT) may occur in more than half of patients receiving veno-venous extracorporeal membrane oxygenation (VV ECMO). CRRT access can be achieved via separate venous access (SVA) or directly “in-line” with the ECMO circuit. Configuration choice is controversial with limited data comparing the two choices. The objective of this study is to compare the efficacy and safety of SVA versus in-line configuration in patients requiring CRRT while on VV ECMO.
Methods: We conducted a retrospective review of patients receiving CRRT while on VV ECMO at a tertiary academic medical center between April 1, 2020 and June 30, 2021. Patients were divided into two groups based on dialysis access configuration: in-line versus SVA. Outcomes included number of days on CRRT, oxygenator lifespan, CRRT filter lifespan, number of interruptions, dialysis blood flow rate, frequency of access site manipulation, and access site bleeding requiring transfusion.
Results: 15 patients required CRRT while on VV ECMO. 7 patients received CRRT via in-line configuration and 6 patients via SVA. One patient transitioned from in-line to SVA during the ECMO run. One patient switched from SVA to in-line during the ECMO run. There was a higher number of days on CRRT in the in-line group (147 vs 74 days). There was no significant difference in oxygenator lifespan (16.9 vs 18.4 days), CRRT filter lifespan (3.3 vs 2.1 days), or number of interruptions (11.56 vs 10.67 per 100 days). Dialysis blood flow rate was similar between groups (324 vs 308 mL/min). SVA was associated with frequent access site manipulation (62.5% of patients) and catheter site bleeding requiring transfusion (25% of patients). All patients were initially anticoagulated with heparin or direct thrombin inhibitor.
Conclusion: Continuous renal replacement therapy can be delivered via separate venous access or in-line configuration in patients requiring VV ECMO. Both configurations display similar efficacy as described by oxygenator and CRRT filter lifespan, number of CRRT interruptions, and dialysis blood flow rates. Separate venous access for CRRT may be associated with higher rates of access associated bleeding and need for access manipulation when compared to in-line configuration.