Optimal connection of the ECMO and CRRT circuits for pediatric patients

Abstract

Continuous renal replacement therapy (CRRT) is commonly combined with extracorporeal membrane oxygenation (ECMO) for pediatric patients owing to the difficulty in securing vascular access in these patients. Moreover, CRRT circuits are commonly connected to ECMO circuits. However, their connection protocol has not yet been standardized, with a trial-and-error approach adopted at each facility. In 2021, our hospital developed a method to connect the return and removal lines of the CRRT circuit to the two side-branch lines between the centrifugal pump and artificial lung of the ECMO circuit. Our method successfully reduced the risk of air contamination and clot and sir embolism in the artificial lung connected to the positive pressure portion of the ECMO circuit. However, as it is connected to the high-pressure portion of the ECMO circuit, CRRT device can cause hypotension and differential pressure alarms due to pressure abnormalities. Nevertheless, our connection method is effective for the combined use of ECMO and CRRT for pediatric patients.