Objective Extracorporeal membrane oxygenation (ECMO) is a supportive cardiopulmonary bypass (CPB) technique for patients with acute respiratory or cardiac failure. Hemofiltration in infants on ECMO is used with the intention to diminish the capillary leakage syndrome, minimize blood transfusions and duration of ECMO.
The objective of the current study is to see if CVVH during ECMO reduces duration of ECMO and overall costs.
Methods Retrospective case-comparison trial. Medical data of patients with hemofiltration during ECMO were matched for age, weight, diagnosis and ECMO mode, to those without hemofiltration (HF) in a 1:3 ratio.
Primary outcome parameters are time on ECMO, time till extubation after decannulation, number of transfusions and costs.
Results Time on ECMO was significantly shorter: 98 (48–187) hours in the HF group compared to 126 (24–403) hours in the control group (P = 0.02). Time from decannulation till extubation was significantly shorter: 2.5 (0–6.4) days and 4.8 (0–121.5) days respectively (p = 0.04). The need for blood transfusions was lower in the HF group 0.9 ml/kg/d (0.2–2.7) compared to the control group 1.8 ml/kg/d (0.8–2.9) (p = 0.001) resulting in a transfusion of an extra 5.4 units of blood per patient. Hemofiltration saved costs of ?5000 per patient.
Conclusions Routine addition of continuous hemofiltration to the ECMO circuit in newborns significantly reduces duration of ECMO and mechanical ventilation post ECMO. Moreover the amount of transfusions can be restricted resulting in a significant reduction in costs.
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