Background/purpose
Children receiving extracorporeal membrane oxygenation (ECMO) for respiratory failure can have significant fluid overload
and renal insufficiency. Addition of inline continuous venovenous hemofiltration (CVVH) could provide additional benefits
in fluid management compared to use of standard medical therapies with ECMO.
Methods
Patients with pediatric respiratory failure receiving ECMO with CVVH were case-matched to similar patients receiving ECMO
without CVVH to compare fluid balance, medication use, and clinical outcomes.
Results
Twenty-six of eighty-six patients with pediatric respiratory failure on ECMO (30%) received CVVH for >24 h (median 7.5 days
on CVVH). Survival was not significantly different between patients receiving CVVH and those who did not receive CVVH (P = 0.51). For ECMO survivors receiving CVVH, overall fluid balance was less than that in non-CVVH survivors (median 25.1 ml kg−1 day−1; range −40.2 to 71.2 vs. 40.2, 1.1 to 134.9; P = 0.028). Time to desired caloric intake was faster in patients receiving CVVH (1 day, 1–5) than in patients who did not
receive CVVH (5 days; 1–11; P < 0.001). Patients receiving CVVH–ECMO also received less furosemide (0.67 vs. 2.11 mg kg−1 day−1; P = 0.009).
Conclusions
Use of CVVH in ECMO was associated with improved fluid balance and caloric intake and less diuretics than in case-matched
ECMO controls.
Keywords Respiratory failure - Continuous venovenous hemofiltration - Extracorporeal - Hemofiltration - ECMO - Renal failure - Pediatrics - Continuous renal replacement therapy