combining crrt with extracorporeal support technologies · separate ecmo and crrt circuits and...

CombiningCRRTwithExtracorporealSupportTechnologies

KeithWille,MDMarch6,2018wille@uab.edu

VV ECMO

Drainage from IVC or SVC

Pump & Oxygenator

Return to RA

VV ECMO

Heart & lung see full CO

Lungs supported

Heart not supported

Basics

VA ECMO

Drainage from RA or Cava

Pump & Oxygenator

Return to Distal Aorta

VA ECMO

Heart & lung see part of CO

Lungs supported

Heart supported

DoubleLumenCannulaforVVECMO

In-HospitalMortality

Methods for combining CRRT with ECMO:• Independent CRRT access• Introduction of a hemofiltration filter into the ECMO circuit• Introduction of a CRRT device into the ECMO circuit

CircuitConfigurationOxygenator

OxygenatorPumpPump

Combined Separated

Circuit Only ECMO circuit Separate ECMO and CRRT circuits

Advantages Only one circuitSame anticoagulation

Ø Fewer pressures alarmsØ Less hemolysisØ Less air embolismØ Flexible anticoagulation

Disadvantages ü Frequent pressures alarmsü Greater hemolysis riskü Higher air embolism riskü Impact on CRRT treatment

Separate ECMO and CRRT circuits and access are needed

Delivery of CRRT and ECMOSeparated vs. combined?

CRRTwithECMO

Ourapproach

InletofCRRTconnectedtothepost-oxygenator site

CRRToutflowconnectedbeforetheCentrifugalpump

Combined line of CRRT-ECMO

CRRTCombinedwithECCO2R

Pumpless extracorporeallungassist ECMO

ECCO2RLungAssist

AvailableECCO2RSystems

Ø ECCO2R or ECMO is the key method of blood purification for hypercapnia-acidosis.

AvailableECLSTechnologies