From the Dipartimento di Emergenza-Urgenza, Ospedale San Gerardo, ASST Monza, Monza, Italy.
Dipartimento di Anestesia-Rianimazione e Emergenza Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
ASAIO J. 2020 Mar;66(3):332-338. doi: 10.1097/MAT.0000000000001003.
Systemic infusion of unfractionated heparin (UFH) is the standard anticoagulation technique for continuous renal replacement therapy (CRRT) during extracorporeal membrane oxygenation (ECMO), but often fails to avoid CRRT circuit clotting. The aim of this study was to assess, in patients undergoing CRRT during venovenous ECMO (vv-ECMO), the efficacy and safety of adding regional citrate anticoagulation (RCA) for CRRT circuit anticoagulation (RCA + UFH group) compared with the sole systemic heparin anticoagulation (UFH group). We performed a retrospective chart review (2009-2018) of patients treated with CRRT during ECMO. We evaluated filter life span, rate of CRRT circuit clotting, and coagulation parameters. The incidence of citrate anticoagulation-related complications was recorded. Forty-eight consecutive adult patients underwent CRRT during vv-ECMO in the study period. The incidence of CRRT circuit clotting was lower in the RCA + UFH group (11% vs. 38% in the UFH group, p < 0.001). Log-rank survival analysis demonstrated longer circuit lifetime for RCA + UFH group. No complication ascribable to citrate anticoagulation was recorded. Regional citrate anticoagulation resulted a feasible, safe, and effective technique as additional anticoagulation for CRRT circuits during ECMO. Compared with systemic heparinization only, this technique allowed to reduce the rate of CRRT circuit clotting.
全身输注未分级肝素（UFH）是体外膜肺氧合（ECMO）期间连续肾脏替代治疗（CRRT）的标准抗凝技术，但常常无法避免 CRRT 回路凝血。本研究旨在评估在接受静脉-静脉 ECMO（vv-ECMO）期间进行 CRRT 的患者中，与单纯全身肝素抗凝（UFH 组）相比，添加局部枸橼酸抗凝（RCA）用于 CRRT 回路抗凝（RCA + UFH 组）的疗效和安全性。我们对 ECMO 期间接受 CRRT 治疗的患者进行了回顾性图表审查（2009-2018 年）。我们评估了滤器寿命、CRRT 回路凝血率和凝血参数。记录了枸橼酸盐抗凝相关并发症的发生率。在研究期间，48 例连续成年患者在 vv-ECMO 期间接受 CRRT。RCA + UFH 组的 CRRT 回路凝血发生率较低（11%比 UFH 组的 38%，p < 0.001）。对数秩生存分析表明 RCA + UFH 组的回路寿命更长。未记录到与枸橼酸盐抗凝相关的并发症。局部枸橼酸抗凝是一种可行、安全且有效的技术，可作为 ECMO 期间 CRRT 回路的附加抗凝剂。与单纯全身肝素化相比，该技术可降低 CRRT 回路凝血的发生率。
