Presentation on theme: "Haemofiltration in newborns treated with extracorporeal membrane oxygenation a case-comparison study Karin Blijdorp, research student Karlien Cransberg,"— Presentation transcript:
Haemofiltration in newborns treated with extracorporeal membrane oxygenation a case-comparison study Karin Blijdorp, research student Karlien Cransberg, pediatric nephrologist Erasmus MC Sophia, Rotterdam, The Netherlands
ECMO treatment in The Netherlands since 1994, in 2 centers University Medical Center, Nijmegen Erasmus MC Sophia, Rotterdam: 40 ECMO runs yearly Indication: acute reversible cardiovascular or respiratory failure with an expected mortality of > 80%: congenital diaphragmatic hernia meconium aspiration syndrome other
Systemic inflammatory response syndrome due to primary disease and/or ECMO system: generalised edema by capillary leakage low blood pressure multi-organ failure prior investigations: hemofiltration added to cardiopulmonary bypass: less SIRS less pulmonary edema with shorter assisted ventilation time improved cardiac function Huang et al, Ann Thorac Surg 2003 Journois et al,Anesthesiology 1994 Journois et al, Anesthesiology 1996 Rivera et al, J Am Coll Cardiol 1998 Davies et al, J Thorac Cardiovasc Surg 1998
Aim of the study Clinical outcome of ECMO treated infants with haemofiltration compared to without. Primary endpoints: Duration of ECMO Duration of assisted ventilation after weaning from ECMO Secondary endpoints: Mortality Fluid balance Vasopressorscore Maximal serum creatinine Transfusion red blood cells & platelets Costs
Methods Retrospective case-comparison study 1:3 Cohort 2004-2006: with hemofiltration (n=15) Inclusion: age < 30 days Exclusion: co-treatment with diuretics start hemofiltration > 3 hrs after start ECMO Cohort 2002-2004: control group without hemofiltration (n=45) Matched for age, weight, diagnosis and mode of ECMO
Haemofiltration in ECMO circuit ECMO-pump clamp heparin substitution fluid Pressure gradient over haemofilter of 40 mmHg
Methods: hemofiltration Filter: Multiflow 100, AN 69 Filtration: 1st 6 hours 100 ml/kg/hr after that 50 ml/kg/hr Standard substitution fluid, with addition of Na/K PO 4 -> [PO 4 ] = 1.5 mmol/l Extra filtration if necessary and possible Isovolemic thrombocyte and blood transfusions
Conclusion Hemofiltration during ECMO: decreases time on ECMO decreases time until extubation after weaning from ECMO decreases need of blood transfusion saves € 9000,- per ECMO run
Conclusion Hemofiltration during ECMO: decreases time on ECMO decreases time until extubation after weaning from ECMO decreases need of blood transfusion saves € 9000,- per ECMO run No significant differences found in: mortality max serum creatinine vasopressorscore extra fluid requirement
Discussion Effect of HF due to More fluid removal? Removal inflammatory mediators?
Take home message Hemofiltration added to ECMO improves clinical outcome and is cost effective
All ECMO nurses on the pediatric ICU D Tibboel, pediatric intensivist, head of PICU SJ Gischler, pediatric intensivist ED Wildschut, pediatric intensivist ED Wolff, pediatric nephrologist Acknowledgements:
Limitations of study More CDH in control group (n.s.) However no difference in ‘severity of illness’ score Groups treated in different time frame Only clinical parameters Prospective study of inflammatory parameters not studied yet
Results: other Controle groep Median (range) HF groep Median (range) Mann-Whitney U test P-waarde Vulling (mL/kg/dag)6 (0-37)4 (0-30)0.25 Vasopressor score7 (0-56)5 (0-41)0.83 Kreatinine (µmol/l)58 (14-91)49 (28-105)0.17 Median (percentile) Mortaliteit7 (16%)3 (21%)0.61
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