Skip to main content
SpringerLink
Log in

Tandem Therapies in Extracorporeal Support

  • Chapter
  • First Online:
Critical Care Nephrology and Renal Replacement Therapy in Children

  • 1338 Accesses

Abstract

Continuous renal replacement therapy (CRRT) has traditionally been used in patients with single organ failure who are hemodynamically unstable enough to tolerate intermittent hemodialysis. However, as technology advances and patient populations become more complex, there are an increasing number of patients with multi-organ failure who require multiple methods of extracorporeal organ support. While theoretical contraindications exist with each established extracorporeal device, additional circuits may be connected in tandem to each other to provide simultaneous extracorporeal organ support. In this chapter, we will discuss the use of multiple extracorporeal therapies, such as extracorporeal membrane oxygenation (ECMO) for cardiac and pulmonary failures, the use of apheresis procedures for liver failure support, in conjunction with CRRT for renal support to provide a total platform of extracorporeal life support (ECLS).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Selewski DT, Charlton JR, Jetton JG, Guillet R, Mhanna MJ, Askenazi DJ, et al. Neonatal acute kidney injury. Pediatrics. 2015;136(2):e463–73.

    Article  PubMed  Google Scholar 

  2. Fortenberry JD, Paden ML, Goldstein SL. Acute kidney injury in children: an update on diagnosis and treatment. Pediatr Clin N Am. 2013;60(3):669–88.

    Article  Google Scholar 

  3. Honore PM, Jacobs R, Hendrickx I, Bagshaw SM, Joannes-Boyau O, Boer W, et al. Prevention and treatment of sepsis-induced acute kidney injury: an update. Ann Intensive Care. 2015;5(1):51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bellomo R, Kellum JA, Ronco C. Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria. Intensive Care Med. 2007;33(3):409–13.

    Article  PubMed  Google Scholar 

  5. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the acute dialysis quality initiative (ADQI) group. Crit Care. 2004;8(4):R204–12.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Askenazi DJ, Ambalavanan N, Hamilton K, Cutter G, Laney D, Kaslow R, et al. Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2011;12(1):e1–6.

    Article  PubMed  Google Scholar 

  8. Smith AH, Hardison DC, Worden CR, Fleming GM, Taylor MB. Acute renal failure during extracorporeal support in the pediatric cardiac patient. ASAIO J. 2009;55(4):412–6.

    Article  PubMed  Google Scholar 

  9. Lou S, MacLaren G, Paul E, Best D, Delzoppo C, Butt W. Hemofiltration is not associated with increased mortality in children receiving extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2015;16(2):161–6.

    Article  PubMed  Google Scholar 

  10. Gadepalli SK, Hirschl RB. Extracorporeal life support: updates and controversies. Semin Pediatr Surg. 2015;24(1):8–11.

    Article  PubMed  Google Scholar 

  11. Luo XJ, Wang W, Hu SS, Sun HS, Gao HW, Long C, et al. Extracorporeal membrane oxygenation for treatment of cardiac failure in adult patients. Interact Cardiovasc Thorac Surg. 2009;9(2):296–300.

    Article  PubMed  Google Scholar 

  12. Selewski DT, Askenazi DJ, Bridges BC, Cooper DS, Fleming GM, Paden ML, et al. The impact of fluid overload on outcomes in children treated with extracorporeal membrane oxygenation: a multicenter retrospective cohort study. Pediatr Crit Care Med. 2017;18(12):1126–35.

    Article  PubMed  Google Scholar 

  13. Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med. 2012;13(3):253–8.

    Article  PubMed  Google Scholar 

  14. Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, Bunchman TE, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010;55(2):316–25.

    Article  Google Scholar 

  15. Davison D, Basu RK, Goldstein SL, Chawla LS. Fluid management in adults and children: core curriculum 2014. Am J Kidney Dis. 2014;63(4):700–12.

    Article  PubMed  Google Scholar 

  16. Roy BJ, Cornish JD, Clark RH. Venovenous extracorporeal membrane oxygenation affects renal function. Pediatrics. 1995;95(4):573–8.

    PubMed  CAS  Google Scholar 

  17. Swaniker F, Kolla S, Moler F, Custer J, Grams R, Barlett R, et al. Extracorporeal life support outcome for 128 pediatric patients with respiratory failure. J Pediatr Surg. 2000;35(2):197–202.

    Article  CAS  PubMed  Google Scholar 

  18. Weber TR, Kountzman B. Extracorporeal membrane oxygenation for nonneonatal pulmonary and multiple-organ failure. J Pediatr Surg. 1998;33(11):1605–9.

    Article  CAS  PubMed  Google Scholar 

  19. Kelly RE Jr, Phillips JD, Foglia RP, Bjerke HS, Barcliff LT, Petrus L, et al. Pulmonary edema and fluid mobilization as determinants of the duration of ECMO support. J Pediatr Surg. 1991;26(9):1016–22.

    Article  PubMed  Google Scholar 

  20. Selewski DT, Cornell TT, Blatt NB, Han YY, Mottes T, Kommareddi M, et al. Fluid overload and fluid removal in pediatric patients on extracorporeal membrane oxygenation requiring continuous renal replacement therapy. Crit Care Med. 2012;40(9):2694–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Goldstein S, Bagshaw S, Cecconi M, Okusa M, Wang H, Kellum J, et al. Pharmacological management of fluid overload. Br J Anaesth. 2014;113(5):756–63.

    Article  PubMed  Google Scholar 

  22. Rosner MH, Ostermann M, Murugan R, Prowle JR, Ronco C, Kellum JA, et al. Indications and management of mechanical fluid removal in critical illness. Br J Anaesth. 2014;113(5):764–71.

    Article  PubMed  Google Scholar 

  23. Fleming GM, Askenazi DJ, Bridges BC, Cooper DS, Paden ML, Selewski DT, et al. A multicenter international survey of renal supportive therapy during ECMO: the kidney intervention during extracorporeal membrane oxygenation (KIDMO) group. ASAIO J. 2012;58(4):407–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Chen H, Yu RG, Yin NN, Zhou JX. Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy in critically ill patients: a systematic review. Crit Care. 2014;18(6):675.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Askenazi DJ, Selewski DT, Paden ML, Cooper DS, Bridges BC, Zappitelli M, et al. Renal replacement therapy in critically ill patients receiving extracorporeal membrane oxygenation. Clin J Am Soc Nephrol. 2012;7(8):1328–36.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Laverdure F, Masson L, Tachon G, Guihaire J, Stephan F. Connection of a renal replacement therapy or plasmapheresis device to the ECMO circuit. ASAIO J. 2017;64(1):122–5.

    Article  Google Scholar 

  27. Jenkins R, Harrison H, Chen B, Arnold D, Funk J. Accuracy of intravenous infusion pumps in continuous renal replacement therapies. ASAIO J. 1992;38(4):808–10.

    PubMed  CAS  Google Scholar 

  28. Sucosky P, Dasi LP, Paden ML, Fortenberry JD, Yoganathan AP. Assessment of current continuous hemofiltration systems and development of a novel accurate fluid management system for use in extracorporeal membrane oxygenation. J Med Dev, Transactions of the ASME. 2008;2(3):035002.

    Google Scholar 

  29. Symons JM, McMahon MW, Karamlou T, Parrish AR, McMullan DM. Continuous renal replacement therapy with an automated monitor is superior to a free-flow system during extracorporeal life support. Pediatr Crit Care Med. 2013;14(9):e404–8.

    Article  PubMed  Google Scholar 

  30. Santiago MJ, Sanchez A, Lopez-Herce J, Perez R, del Castillo J, Urbano J, et al. The use of continuous renal replacement therapy in series with extracorporeal membrane oxygenation. Kidney Int. 2009;76(12):1289–92.

    Article  PubMed  Google Scholar 

  31. Shum HP, Kwan AM, Chan KC, Yan WW. The use of regional citrate anticoagulation continuous venovenous hemofiltration in extracorporeal membrane oxygenation. ASAIO J. 2014;60(4):413–8.

    Article  CAS  PubMed  Google Scholar 

  32. Barbaro RP, Paden ML, Guner YS, Raman L, Ryerson LM, Alexander P, et al. Pediatric extracorporeal life support organization registry international report 2016. ASAIO J. 2017;63(4):456–63.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Thiagarajan RR, Barbaro RP, Rycus PT, McMullan DM, Conrad SA, Fortenberry JD, et al. Extracorporeal life support organization registry international report 2016. ASAIO J. 2017;63(1):60–7.

    Article  PubMed  Google Scholar 

  34. Selewski DT, Askenazi DJ, Bridges BC, Cooper DS, Fleming GM, Paden ML, Verway M, Sahay R, King E, Zappitelli M. The impact of fluid overload on outcome of children treated with extracorporeal membrane oxygenation: a multicenter retrospective cohort study. Pediatr Crit Care Med. 2017;18(12):1126–35.

    Article  PubMed  Google Scholar 

  35. Kawai Y, Cornell TT, Cooley EG, Beckman CN, Baldridge PK, Mottes TA, et al. Therapeutic plasma exchange may improve hemodynamics and organ failure among children with sepsis-induced multiple organ dysfunction syndrome receiving extracorporeal life support. Pediatr Crit Care Med. 2015;16(4):366–74.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the writing committee of the American society for apheresis: the seventh special issue. J Clin Apher. 2016;31(3):149–62.

    PubMed  Google Scholar 

  37. Sirignano RM, Meyer EK, Fasano R, Paden ML. Pediatric tandem therapeutic apheresis: a multidisciplinary approach. ASAIO J. 2017. https://doi.org/10.1097/MAT.0000000000000641.

  38. Nguyen TC, Cruz MA, Carcillo JA. Thrombocytopenia-associated multiple organ failure and acute kidney injury. Crit Care Clin. 2015;31(4):661–74.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Dyer M, Neal MD, Rollins-Raval MA, Raval JS. Simultaneous extracorporeal membrane oxygenation and therapeutic plasma exchange procedures are tolerable in both pediatric and adult patients. Transfusion. 2014;54(4):1158–65.

    Article  CAS  PubMed  Google Scholar 

  40. Bridges BC, Hardison D, Pietsch J. A case series of the successful use of ECMO, continuous renal replacement therapy, and plasma exchange for thrombocytopenia-associated multiple organ failure. J Pediatr Surg. 2013;48(5):1114–7.

    Article  PubMed  Google Scholar 

  41. Jamal JA, Economou CJ, Lipman J, Roberts JA. Improving antibiotic dosing in special situations in the ICU: burns, renal replacement therapy and extracorporeal membrane oxygenation. Curr Opin Crit Care. 2012;18(5):460–71.

    Article  PubMed  Google Scholar 

  42. Hohenforst-Schmidt W, Petermann A, Visouli A, Zarogoulidis P, Darwiche K, Kougioumtzi I, et al. Successful application of extracorporeal membrane oxygenation due to pulmonary hemorrhage secondary to granulomatosis with polyangiitis. Drug Des Devel Ther. 2013;7:627–33.

    PubMed  PubMed Central  Google Scholar 

  43. Patel P, Nandwani V, Vanchiere J, Conrad SA, Scott LK. Use of therapeutic plasma exchange as a rescue therapy in 2009 pH1N1 influenza A--an associated respiratory failure and hemodynamic shock. Pediatr Crit Care Med. 2011;12(2):e87–9.

    Article  PubMed  Google Scholar 

  44. Tabbutt S, Leonard M, Godinez RI, Sebert M, Cullen J, Spray TL, et al. Severe influenza B myocarditis and myositis. Pediatr Crit Care Med. 2004;5(4):403–6.

    Article  PubMed  Google Scholar 

  45. Mok Q, Butt W. The outcome of children admitted to intensive care with meningococcal septicaemia. Intensive Care Med. 1996;22(3):259–63.

    Article  CAS  PubMed  Google Scholar 

  46. Maclaren G, Butt W, Cameron P, Preovolos A, McEgan R, Marasco S. Treatment of polypharmacy overdose with multimodality extracorporeal life support. Anaesth Intensive Care. 2005;33(1):120–3.

    PubMed  CAS  Google Scholar 

  47. Nasir S, Kilic YA, Karaaltin MV, Erdem Y. Lessons learned from the first quadruple extremity transplantation in the world. Ann Plast Surg. 2014;73(3):336–40.

    PubMed  CAS  Google Scholar 

  48. Barnes SL, Naughton M, Douglass J, Murphy D. Extracorporeal membrane oxygenation with plasma exchange in a patient with alveolar haemorrhage secondary to Wegener’s granulomatosis. Intern Med J. 2012;42(3):341–2.

    Article  CAS  PubMed  Google Scholar 

  49. Ahmed SH, Aziz T, Cochran J, Highland K. Use of extracorporeal membrane oxygenation in a patient with diffuse alveolar hemorrhage. Chest. 2004;126(1):305–9.

    Article  PubMed  Google Scholar 

  50. Yusuff H, Malagon I, Robson K, Parmar J, Hamilton P, Falter F. Extracorporeal membrane oxygenation for life-threatening ANCA-positive pulmonary capillaritis. A review of UK experience. Heart Lung Vessel. 2015;7(2):159–67.

    PubMed  PubMed Central  Google Scholar 

  51. Joseph M, Charles AG. Early extracorporeal life support as rescue for Wegener granulomatosis with diffuse alveolar hemorrhage and acute respiratory distress syndrome: a case report and literature review. Pediatr Emerg Care. 2011;27(12):1163–6.

    Article  PubMed  Google Scholar 

  52. Di Maria MV, Hollister R, Kaufman J. Case report: severe microscopic polyangiitis successfully treated with extracorporeal membrane oxygenation and immunosuppression in a pediatric patient. Curr Opin Pediatr. 2008;20(6):740–2.

    Article  PubMed  Google Scholar 

  53. Dalabih A, Pietsch J, Jabs K, Hardison D, Bridges BC. Extracorporeal membrane oxygenation as a platform for recovery: a case report of a child with pulmonary hemorrhage, refractory hypoxemic respiratory failure, and new onset goodpasture syndrome. J Extra Corpor Technol. 2012;44(2):75–7.

    PubMed  PubMed Central  Google Scholar 

  54. Hites M, Dell’Anna AM, Scolletta S, Taccone FS. The challenges of multiple organ dysfunction syndrome and extra-corporeal circuits for drug delivery in critically ill patients. Adv Drug Deliv Rev. 2014;77:12–21.

    Article  CAS  PubMed  Google Scholar 

  55. Nguyen TC, Han YY, Kiss JE, Hall MW, Hassett AC, Jaffe R, et al. Intensive plasma exchange increases a disintegrin and metalloprotease with thrombospondin motifs-13 activity and reverses organ dysfunction in children with thrombocytopenia-associated multiple organ failure. Crit Care Med. 2008;36(10):2878–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Kolovos NS, Schuerer DJ, Moler FW, Bratton SL, Swaniker F, Bartlett RH, et al. Extracorporal life support for pulmonary hemorrhage in children: a case series. Crit Care Med. 2002;30(3):577–80.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Critical Care, Emory University, Atlanta, GA, USA

    Rachel Sirignano, Meral Patel & Matthew L. Paden

Authors
  1. Rachel Sirignano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meral Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew L. Paden
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew L. Paden .

Editor information

Editors and Affiliations

  1. Paediatric Intensive Care Unit, King’s College Hospital, London, United Kingdom

    Akash Deep

  2. Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

    Stuart L. Goldstein

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sirignano, R., Patel, M., Paden, M.L. (2018). Tandem Therapies in Extracorporeal Support. In: Deep, A., Goldstein, S. (eds) Critical Care Nephrology and Renal Replacement Therapy in Children. Springer, Cham. https://doi.org/10.1007/978-3-319-90281-4_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90281-4_22

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90280-7

  • Online ISBN: 978-3-319-90281-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation