Hemofiltration Reduces Extracorporeal Membrane Oxygenation Time

Researchers at the Sophia Children's Hospital at Erasmus Medical Center (Rotterdam, The Netherlands) examined demographic data of 15 newborns treated with hemofiltration during ECMO compared to 46 control patients treated without hemofiltration. Primary outcome parameters were time on ECMO, time until extubation after decannulation, mortality and potential cost reduction. Secondary outcome parameters were total and mean fluid balance, urine output, vasopressor dosis, blood products and fluid bolus infusions, serum creatinin, urea, and albumin levels.

The researchers found that not only was time on ECMO significantly decreased in the hemofiltration group (98 hours as opposed to 126 hours) but that the hemofiltration patients also needed fewer blood transfusions, and that fluid balance per day was significantly lower. Time from decannulation until extubation was shorter as well: 2.5 days versus 4.8 days. The calculated cost reduction was EUR 5,000 per ECMO run. There were no significant differences in mortality. There was no significant difference in inotropic support or other fluid resuscitation. The researchers believe that hemofiltration mitigates the inflammatory effects and complications of ECMO, including capillary leakage syndrome, which can lead to fluid imbalance, hypotension and, ultimately, organ failure. The study was published on April 3, 2009, in Critical Care, a publication of BioMEd Central.

"Adding continuous hemofiltration to the ECMO circuit in newborns improves short term outcomes by significantly reducing time on ECMO and by a possible reduction of systemic inflammatory response syndrome and capillary leakage syndrome," said lead author Dick Tibboel, M.D., Ph.D., head of the pediatric surgical intensive care unit (pICU). "Fewer blood transfusions are needed. All in all, overall costs per extracorporeal membrane oxygenation run will be lower."

ECMO is a supportive cardiopulmonary bypass technique for patients with acute reversible cardiovascular or respiratory failure. The ECMO machine is similar to a heart-lung machine; to initiate ECMO, cannulae are placed in large blood vessels to provide access to the patient's blood. Anticoagulant drugs (usually heparin) are given to prevent blood clotting. The ECMO machine continuously pumps blood from the patient through a "membrane oxygenator" that imitates the gas exchange process of the lungs, removing carbon dioxide (CO2) and adding oxygen. The oxygenated blood is then returned to the patient.

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