Hemofiltration Is Not Associated With Increased Mortality in Children Receiving Extracorporeal Membrane Oxygenation*. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Lou, Song; MacLaren, Graeme; Paul, Eldho; Best, Derek; Delzoppo, Carmel; Butt, Warwick
• Is Part Of: Pediatric critical care medicine. Volume 16:Issue 2(2015)
• Publication Date: 2015-02
• Subjects: Pediatric intensive care -- Periodicals; Pediatric emergencies -- Periodicals; 618.05
• DOI: 10.1097/PCC.0000000000000290
• Languages: English
• ISSNs: 1529-7535

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objectives:</title> <p>To investigate whether the use of continuous renal replacement therapy is independently associated with increased in-hospital mortality in children on extracorporeal membrane oxygenation.</p> </sec> <sec> <title>Design:</title> <p>Retrospective, 1:1 propensity-matched cohort study.</p> </sec> <sec> <title>Setting:</title> <p>Tertiary PICU.</p> </sec> <sec> <title>Patients:</title> <p>Eighty-six children on extracorporeal membrane oxygenation, 43 of whom also received hemofiltration.</p> </sec> <sec> <title>Interventions:</title> <p>None.</p> </sec> <sec> <title>Measurements and Main Results:</title> <p>Demographics, pre–extracorporeal membrane oxygenation hemodynamic data, fluid status, and biochemistry tests were collected, as well as duration of extracorporeal membrane oxygenation, blood product use, complications, and mortality. Forty-three children receiving extracorporeal membrane oxygenation and continuous renal replacement therapy were matched to a cohort of 43 children on extracorporeal membrane oxygenation not receiving continuous renal replacement therapy. The main indication for hemofiltration was fluid overload in 29 patients (67.4%), renal failure in nine patients (20.9%), and electrolyte abnormalities in five patients (11.6%). The median duration of hemofiltration was 108 hours (47–209 hr). Patients receiving hemofiltration had a longer duration of extracorporeal membrane oxygenation (127 hr [94–302 hr] vs 121 hr [67–182 hr]; <italic>p</italic> = 0.05) and received more platelet transfusions (0.91 mL/kg/hr [0.43–1.58 mL/kg/hr] vs 0.63 mL/kg/hr [0.30–0.79 mL/kg/hr]; <italic>p</italic> = 0.01). There were otherwise no differences in mechanical or patient-related complications between both groups. There was no difference in the proportion of patients who were successfully decannulated (81.4% vs 74.4%; <italic>p</italic> = 0.44), survived to ICU discharge (65.1% vs 55.8%; <italic>p</italic> = 0.38), or survived to hospital discharge (62.8% vs 48.8%; <italic>p</italic> = 0.19) in the controls versus the hemofiltration group.</p> </sec> <sec> <title>Conclusions:</title> <p>In-hospital mortality was similar between children on extracorporeal membrane oxygenation with and without hemofiltration although hemofiltration appeared to be associated with a slight increase in the duration of extracorporeal membrane oxygenation and more liberal platelet transfusions.</p> </sec> </abstract>