Combination of Continuous Renal Replacement Therapies (CRRT) and Extracorporeal Membrane Oxygenation (ECMO) for Advanced Cardiac Patients

Background: The critically ill patients may require mechanical ventilation, cardiac mechanical support and other types of vital supports. Extracorporeal membrane oxygenation (ECMO) is a supportive therapy used to provide good cardiopulmonary and end-organ support. Continuous renal replacement therapies (CRRT) display important advantages in terms of clinical tolerance and blood purification. The objectives is to assess the effect of combining these two technologies. Methods: Between December 1998 and June 2001, 10 adult cardiac patients were treated on ECMO. Five of them were treated with both ECMO and CRRT. The clinical outcomes were retrospectively evaluated. Results: Of the 10 patients studied, 5 were men and 5 were women. The mean age of survivors and non-surviivors was 37.00 ± 14.54 years and 46.17 ± 7.41 years. The overall mortality rate was 60%. There were no significant differences between survivors and non-survivors in terms of age or gender. The cause of death in the majority of patients was related to organ system failure during the 24 hours immediately preceding the initiation of ECMO. Five patients with acute renal failure treated by CRRT were invariably associated with a fatal outcome. The median and mean survival in this group on CRRT was 40.50 ± 18.07 hours and 92.60 ± 60.50 hours. Conclusion: We conclude that mortality rate for acute renal failure in cardiac patients under ECMO continues to be high. Our findings suggest that acute renal failure is usually a part of multiorgan failure complex. Renal failure alone should not the only reason for the mortality of these patients in whom renal failure is often a part of this complex problem. Combination of CRRT and ECMO might serve an alternative therapy bridging the temporary replacement treatment and heart transplantation in advanced cardiac patients.

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