PMID- 31045918
OWN - NLM
STAT- MEDLINE
DCOM- 20201105
LR  - 20210125
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 66
IP  - 3
DP  - 2020 Mar
TI  - Continuous Renal Replacement Therapy in Venovenous Extracorporeal Membrane 
      Oxygenation: A Retrospective Study on Regional Citrate Anticoagulation.
PG  - 332-338
LID - 10.1097/MAT.0000000000001003 [doi]
AB  - Systemic infusion of unfractionated heparin (UFH) is the standard anticoagulation 
      technique for continuous renal replacement therapy (CRRT) during extracorporeal 
      membrane oxygenation (ECMO), but often fails to avoid CRRT circuit clotting. The 
      aim of this study was to assess, in patients undergoing CRRT during venovenous 
      ECMO (vv-ECMO), the efficacy and safety of adding regional citrate 
      anticoagulation (RCA) for CRRT circuit anticoagulation (RCA + UFH group) compared 
      with the sole systemic heparin anticoagulation (UFH group). We performed a 
      retrospective chart review (2009-2018) of patients treated with CRRT during ECMO. 
      We evaluated filter life span, rate of CRRT circuit clotting, and coagulation 
      parameters. The incidence of citrate anticoagulation-related complications was 
      recorded. Forty-eight consecutive adult patients underwent CRRT during vv-ECMO in 
      the study period. The incidence of CRRT circuit clotting was lower in the RCA + 
      UFH group (11% vs. 38% in the UFH group, p < 0.001). Log-rank survival analysis 
      demonstrated longer circuit lifetime for RCA + UFH group. No complication 
      ascribable to citrate anticoagulation was recorded. Regional citrate 
      anticoagulation resulted a feasible, safe, and effective technique as additional 
      anticoagulation for CRRT circuits during ECMO. Compared with systemic 
      heparinization only, this technique allowed to reduce the rate of CRRT circuit 
      clotting.
FAU - Giani, Marco
AU  - Giani M
AD  - From the Dipartimento di Emergenza-Urgenza, Ospedale San Gerardo, ASST Monza, 
      Monza, Italy.
FAU - Scaravilli, Vittorio
AU  - Scaravilli V
AD  - Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' 
      Granda Ospedale Maggiore Policlinico, Milano, Italy.
FAU - Stefanini, Flavia
AU  - Stefanini F
AD  - Dipartimento di Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca, 
      Monza, Italy.
FAU - Valsecchi, Gabriele
AU  - Valsecchi G
AD  - Dipartimento di Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca, 
      Monza, Italy.
FAU - Rona, Roberto
AU  - Rona R
AD  - From the Dipartimento di Emergenza-Urgenza, Ospedale San Gerardo, ASST Monza, 
      Monza, Italy.
FAU - Grasselli, Giacomo
AU  - Grasselli G
AD  - Dipartimento di Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca, 
      Monza, Italy.
AD  - Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Universita 
      degli Studi di Milano, Milano, Italy.
FAU - Bellani, Giacomo
AU  - Bellani G
AD  - From the Dipartimento di Emergenza-Urgenza, Ospedale San Gerardo, ASST Monza, 
      Monza, Italy.
AD  - Dipartimento di Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca, 
      Monza, Italy.
FAU - Pesenti, Antonio M
AU  - Pesenti AM
AD  - Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' 
      Granda Ospedale Maggiore Policlinico, Milano, Italy.
AD  - Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Universita 
      degli Studi di Milano, Milano, Italy.
FAU - Foti, Giuseppe
AU  - Foti G
AD  - From the Dipartimento di Emergenza-Urgenza, Ospedale San Gerardo, ASST Monza, 
      Monza, Italy.
AD  - Dipartimento di Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca, 
      Monza, Italy.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
RN  - 0 (Anticoagulants)
RN  - 2968PHW8QP (Citric Acid)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/*therapeutic use
MH  - Blood Coagulation
MH  - Citric Acid/*therapeutic use
MH  - Continuous Renal Replacement Therapy/*adverse effects
MH  - *Extracorporeal Membrane Oxygenation
MH  - Female
MH  - Heparin/therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
EDAT- 2019/05/03 06:00
MHDA- 2020/11/06 06:00
CRDT- 2019/05/03 06:00
PHST- 2019/05/03 06:00 [pubmed]
PHST- 2020/11/06 06:00 [medline]
PHST- 2019/05/03 06:00 [entrez]
AID - 00002480-202003000-00016 [pii]
AID - 10.1097/MAT.0000000000001003 [doi]
PST - ppublish
SO  - ASAIO J. 2020 Mar;66(3):332-338. doi: 10.1097/MAT.0000000000001003.