Continuous renal replacement therapy and extracorporeal membrane oxygenation: implications in the COVID-19 era

Perfusion. 2021 Sep 8:2676591211042561. doi: 10.1177/02676591211042561. Online ahead of print.ABSTRACTThe novel severe acute respiratory syndrome coronavirus 2, SARS-CoV-2 (coronavirus Disease 19 (COVID-19)) was identified as the causative agent of viral pneumonias in Wuhan, China in December 2019, and has emerged as a pandemic causing acute respiratory distress syndrome (ARDS) and multiple organ dysfunction. Interim guidance by the World Health Organization states that extracorporeal membrane oxygenation (ECMO) should be considered as a rescue therapy in COVID-19-related ARDS. International registries tracking ECMO in COVID-19 patients reveal a 21%-70% incidence of acute renal injury requiring renal replacement therapy (RRT) during ECMO support. The indications for initiating RRT in patients on ECMO are similar to those for patients not requiring ECMO. RRT can be administered during ECMO via a temporary dialysis catheter, placement of a circuit in-line hemofilter, or direct connection of continuous RRT in-line with the ECMO circuit. Here we review methods for RRT during ECMO, RRT initiation and timing during ECMO, anticoagulation strategies, and novel cytokine filtration approaches to minimize COVID-19's pathophysiological impact.PMID:34494489 | DOI:10.1177/02676591211042561

Source: Perfusion - September 8, 2021 Category: Cardiovascular & Thoracic Surgery Authors: Sophia H Roberts Matthew L Goodwin Christopher M Bobba Omar Al-Qudsi S Veena Satyapriya Ravi S Tripathi Thomas J Papadimos Bryan A Whitson Source Type: research