To investigate whether the use of continuous renal replacement therapy
is independently associated with increased in-hospital mortality in children on extracorporeal membrane oxygenation.
Retrospective, 1:1 propensity-matched cohort study.
Eighty-six children on extracorporeal membrane oxygenation, 43 of whom also received hemofiltration.
Measurements and Main Results:
Demographics, pre–extracorporeal membrane oxygenation hemodynamic data, fluid status, and biochemistry tests were collected, as well as duration of extracorporeal membrane oxygenation, blood product use, complications, and mortality. Forty-three children receiving extracorporeal membrane oxygenation and continuous renal replacement therapy
were matched to a cohort of 43 children on extracorporeal membrane oxygenation not receiving continuous renal replacement therapy
. The main indication for hemofiltration was fluid overload in 29 patients (67.4%), renal failure
in nine patients (20.9%), and electrolyte abnormalities in five patients (11.6%). The median duration of hemofiltration was 108 hours (47–209 hr). Patients receiving hemofiltration had a longer duration of extracorporeal membrane oxygenation (127 hr [94–302 hr] vs 121 hr [67–182 hr]; p
= 0.05) and received more platelet transfusions (0.91 mL/kg/hr [0.43–1.58 mL/kg/hr] vs 0.63 mL/kg/hr [0.30–0.79 mL/kg/hr]; p
= 0.01). There were otherwise no differences in mechanical or patient-related complications between both groups. There was no difference in the proportion of patients who were successfully decannulated (81.4% vs 74.4%; p
= 0.44), survived to ICU discharge (65.1% vs 55.8%; p
= 0.38), or survived to hospital discharge (62.8% vs 48.8%; p
= 0.19) in the controls versus the hemofiltration group.
In-hospital mortality was similar between children on extracorporeal membrane oxygenation with and without hemofiltration although hemofiltration appeared to be associated with a slight increase in the duration of extracorporeal membrane oxygenation and more liberal platelet transfusions.