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Kidney Week

Abstract: FR-PO466

Easy, Simple, and Effective Pressure Control by Pinch Valve in CRRT Directly Connected to Extracorporeal Membrane Oxygenation

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kim, Haksoo, Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
  • Shin, Seulgi, Department of Nursing, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
  • Chang, Jai won, Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
Background

The simultaneous use of continuous renal replacement therapy (CRRT) and extracorporeal membrane oxygenation (ECMO) is increasing in the patients with AKI coexisting with respiratory or circulatory failure in ICU. However, there are no recommended techniques to combine them. Pinch valve is suitable for handling flow capacity by throttling line without corrosion or contamination. Therefore, we investigated whether the external use of pinch valve on the blood lines of CRRT connected to ECMO is helpful to maintain the pressures of CRRT lines in the acceptable pressure range without modifying ECMO settings or inhibiting pressure alarms of CRRT.

Methods

We conducted a prospective observational study in 14 patients (M:F=8:6, age median 50.5 (range 21~75) years, SOFA score 12 (4~16)) requiring CRRT (blood flow rate 150 ml/min) and ECMO (veno-arterial:veno-venous=12:2, FiO2 60 (40~100) %, cardiac support 90 (70~125) % of normal cardiac index, blood flow rate 3.8 (2.9~5.0) L/min, sweep gas flow 3.0 (1.0~5.0) L/min) between Aug and Oct 2018. The connections of CRRT to ECMO were performed 41 times. Inflow CRRT line is connected after the oxygenator and the outflow CRRT line, before the blood pump in the ECMO circuit. Pinch valve was externally used on inflow and outflow lines of CRRT.

Results

The initial blood flow rate of CRRT was 150 ml/min. Any reduction of blood flow in CRRT on ECMO was not necessary. Before the application of pinch valve, the pressures of CRRT were too high or too low to maintain CRRT directly connected to ECMO circuit. However, after the application of pinch valve, the pressures of CRRT were tolerable and significantly different (*p<0.05, **p<0.001) from those before the use of pinch valve. CRRT alarms disappeared owing to pinch valve. The changes of CRRT pressures were summarized in Table(Mean±SEM). The median life span of CRRT filter was 63 (range 10~72) hours.

Conclusion

Management of line pressures in CRRT connected to ECMO could be easy, simple and effective by the external application of pinch valve without inhibiting CRRT alarms.

CRRT Pressures
on ECMO
(mmHg)
Tolerable
Range by
company
Before use
of pinch
valve
After use of pinch valve
0 hour
(n=41)
24 hours
(n=32)
48 hours
(n=28)
72 hours
(n=19)
Access-150 ~ -50165 ± 1551 ± 11**40 ± 14**58 ± 14**52 ± 16**
Filter+100 ~ +250-11 ± 9127 ± 5**148 ± 6**158 ± 8**146 ± 9**
Effluent-150 ~ +50-96 ± 927 ± 5**2 ± 5**-27 ± 10**-45 ± 17*
Return+50 ~ +150-62 ± 983 ± 4**85 ± 9**87 ± 5**70 ± 8**
Transmembrane~ +45047 ± 361 ± 3**97 ± 5**129 ± 10**134 ± 17**