PMID- 12739825
OWN - NLM
STAT- MEDLINE
DCOM- 20030822
LR  - 20220309
IS  - 0886-022X (Print)
IS  - 0886-022X (Linking)
VI  - 25
IP  - 2
DP  - 2003 Mar
TI  - Combination of continuous renal replacement therapies (CRRT) and extracorporeal 
      membrane oxygenation (ECMO) for advanced cardiac patients.
PG  - 183-93
AB  - BACKGROUND: The critically ill patients may require mechanical ventilation, 
      cardiac mechanical support, and other types of critical support. Extracorporeal 
      membrane oxygenation (ECMO) is a supportive therapy, which provides good 
      cardiopulmonary and end-organ support. Continuous renal replacement therapies 
      (CRRT) exhibit important advantages in terms of clinical tolerance and blood 
      purification. This investigation aims to evaluate the acute renal failure in 
      cardiac patients under ECMO, and assess the effect of combining these two 
      technologies, ECMO and CRRT. 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 analyzed. RESULTS: Of 
      the 10 patients studied, five were men and five were women. The mean age of 
      survivors and non-survivors was 37.00 +/- 14.54 years and 46.17 +/- 7.41 years, 
      respectively. The overall mortality rate was 60%. Survivors did not differ 
      significantly from non-survivors in age or gender. The APACHE II scores on the 
      first day of ECMO support between survival and non-survival were 19.00 +/- 9.38 
      and 24.67 +/- 3.50 (P value = 0.392) (Table 2), which demonstrates no significant 
      differences too. The cause of death in most patients was related to organ system 
      failure during the 24 h immediately before ECMO started. Five patients with acute 
      renal failure treated by CRRT were eventually died. The median and mean survival 
      in this group on CRRT was 40.50 +/- 18.07 h and 92.60 +/- 60.50 h. CONCLUSION: We 
      conclude that mortality rate for acute renal failure in cardiac patients under 
      ECMO continues to be high. Our data suggest that acute renal failure is generally 
      a part of multiorgan failure. This unique form of acute renal failure, causes 
      generalized edema and fluid overload despite still low serum creatinine and 
      azotemia, and deteriorates rapidly to death. From this study shows, advanced 
      cardiac failure may need more aggressive and early initiation of ECMO support 
      before acute renal failure develops. Acute renal failure in advanced heart 
      failure under ECMO support means a grave sign, need aggressive heart 
      transplantation therapy as soon as possible. Combination of CRRT and ECMO might 
      serve an alternative therapy bridging the temporary replacement treatment and 
      heart transplantation in advanced cardiac patients.
FAU - Yap, Hon-Jek
AU  - Yap HJ
AD  - Division of Critical Care Nephrology, Section of Nephrology, Department of 
      Medicine, Chang Gung Memorial Hospital, Chang Gung University, Kweishan, Taoyuan, 
      Taiwan.
FAU - Chen, Yung-Chang
AU  - Chen YC
FAU - Fang, Ji-Tseng
AU  - Fang JT
FAU - Huang, Chiu-Ching
AU  - Huang CC
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - England
TA  - Ren Fail
JT  - Renal failure
JID - 8701128
SB  - IM
MH  - APACHE
MH  - Acute Kidney Injury/*etiology/mortality/*therapy
MH  - Adult
MH  - Combined Modality Therapy
MH  - Critical Care
MH  - Extracorporeal Membrane Oxygenation/*adverse effects
MH  - Female
MH  - Heart Diseases/*mortality/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multiple Organ Failure/*etiology/mortality/*prevention & control
MH  - Outcome Assessment, Health Care
MH  - *Renal Replacement Therapy
MH  - Retrospective Studies
MH  - Survival Rate
EDAT- 2003/05/13 05:00
MHDA- 2003/08/23 05:00
CRDT- 2003/05/13 05:00
PHST- 2003/05/13 05:00 [pubmed]
PHST- 2003/08/23 05:00 [medline]
PHST- 2003/05/13 05:00 [entrez]
AID - 10.1081/jdi-120018719 [doi]
PST - ppublish
SO  - Ren Fail. 2003 Mar;25(2):183-93. doi: 10.1081/jdi-120018719.