The Effect of Simultaneous Renal Replacement Therapy on Extracorporeal Membrane Oxygenation Support for Cardiogenic Shock Patients

Launched by BEIJING ANZHEN HOSPITAL · Aug 16, 2016

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ClinConnect Summary

Background:

Extracorporeal membrane oxygenation (ECMO) is a temporary mechanical circulatory support device for cardiogenic shock (CS) patients. Patients with fluid overload (FO) and sever metabolic disorder in the early phase of ECMO support exhibit higher hospital mortality. Simultaneous renal replacement therapy (RRT) is routinely used to facilitate more rapid metabolic or uremic control and more effective prevention and management of fluid overload when ECMO is commenced in some ECMO centers registered in the Extracorporeal Life Support Organization (ELSO). However, high-quality eviden...

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Eligibility criteria

• Inclusion Criteria:
• • 1. Age ≥ 18 and ≤ 70 years.
• • 2. Admission to ICU.
• • 3. Criteria for the diagnosis of CS as follows: (1) systolic blood pressure less than 90 mmHg for 30 min, a mean arterial pressure less than 65 mmHg for 30 min, or vasopressors required to achieve a blood pressure ≥ 90 mmHg; (2) pulmonary congestion or elevated left-ventricular filling pressures; and (3) signs of impaired organ perfusion with at least one of the following criteria: (a) altered mental status; (b) cold, clammy skin; (c) oliguria; and (d) increased serum lactate.
• • 4. ECMO will supply cardiopulmonary support to the patient.
• Exclusion Criteria:
• • 1. Refusal of consent.
• • 2. Received or decided to receive RRT before ECMO was commenced.
• • 3. Fulfilled the criteria for Chronic Kidney Disease (either of the following present for \>3 months): (1) Albuminuria (albumin excretion rate \> 30 mg/24 hours; albumin-to-creatinine ratio \> 30 mg/g); (2) urine sediment abnormalities; (3) electrolyte and other abnormalities due to tubular disorders; (4) abnormalities detected by histology; (5) structural abnormalities detected by imaging; and (6) history of kidney transplantation.
• • 4. Received ECMO bridging to a long-term ventricle assist device or heart transplantation.