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Continuous Renal Replacement Therapy in Venovenous Extracorporeal Membrane Oxygenation

A Retrospective Study on Regional Citrate Anticoagulation

Giani, Marco*; Scaravilli, Vittorio; Stefanini, Flavia; Valsecchi, Gabriele; Rona, Roberto*; Grasselli, Giacomo†,§; Bellani, Giacomo*,‡; Pesenti, Antonio M.†,§; Foti, Giuseppe*,‡

doi: 10.1097/MAT.0000000000001003
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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.

From the *Dipartimento di Emergenza-Urgenza, Ospedale San Gerardo, ASST Monza, Monza, Italy

Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy

Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca, Monza, Italy

§Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy.

Submitted for consideration November 2018; accepted for publication in revised form March 2019.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site(www.asaiojournal.com)

Correspondence: Marco Giani, Rianimazione Generale, Ospedale San Gerardo, ASST Monza, Via Pergolesi 33, 20900, Monza, Italy. Email: marco.giani84@gmail.com.

Copyright © 2019 by the American Society for Artificial Internal Organs