Table 3 Advantages and disadvantages of RRT techniques during extracorporeal membrane oxygenation (ECMO) [31, 33]
Techniques | Advantages | Disadvantages |
|---|---|---|
In-line hemofilter | Low cost Generates large volumes of UF No need for separate anticoagulation Small priming volume | No pressure monitoring Requires external infusion device to control UF and deliver replacement fluid Less precise UF Limited solute clearance Flow turbulence and risk of hemolysis |
Independent RRT access (parallel system) | Allows fine-tune adjustment of solute and fluid removal Able to provide RRT independent of ECMO Allows use of regional anticoagulation Simplified circuit changing without need for perfusionist Mode of solute clearance not restricted | Need for separate vascular access Risk of mechanical and infectious complications Higher extracorporeal blood volume Technically more complex to manage two separate circuits |
RRT connected to ECMO circuit (integrated system) | Allows fine-tune adjustment of solute and fluid removal Mode of solute clearance not restricted No need for separate vascular access Avoids complications related to line insertion | Pressure alarms (low pressure alarms if connected pre-pump and high pressure alarms when connected post-pump) Requires a RRT machine capable of adjusting alarm settings Risk of air entrapment if access line is connected before centrifugal pump Flow turbulence with risk of hemolysis and thrombus formation Generation of shunt within ECMO circuit Recirculation |