Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Semin Dial. 2021 Nov;34(6):537-549. doi: 10.1111/sdi.12965. Epub 2021 Mar 25.
Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy utilized for patients with severe life-threatening cardiorespiratory failure. Patients treated with ECMO are among the most severely ill encountered in critical care and are at high-risk of developing multiple organ dysfunction, including acute kidney injury (AKI) and fluid overload. Continuous renal replacement therapy (CRRT) is increasingly utilized inpatients on ECMO to manage AKI and treat fluid overload. The indications for renal replacement therapy for patients on ECMO are similar to those of other critically ill populations; however, there is wide practice variation in how renal supportive therapies are utilized during ECMO. For patients requiring both CRRT and ECMO, CRRT may be connected directly to the ECMO circuit, or CRRT and ECMO may be performed independently. This review will summarize current knowledge of the epidemiology of AKI, indications and timing of CRRT, delivery of CRRT, and the outcomes of patients requiring CRRT with ECMO.
体外膜肺氧合（ECMO）是一种用于治疗严重危及生命的心呼吸衰竭患者的救生疗法。接受 ECMO 治疗的患者是重症监护中最严重的患者之一，他们有发生多器官功能障碍的高风险，包括急性肾损伤（AKI）和液体超负荷。连续肾脏替代疗法（CRRT）越来越多地用于 ECMO 患者，以治疗 AKI 和液体超负荷。ECMO 患者进行肾脏替代治疗的适应证与其他危重病患者相似；然而，在 ECMO 期间如何使用肾脏支持治疗方面存在广泛的实践差异。对于需要同时进行 CRRT 和 ECMO 的患者，CRRT 可以直接连接到 ECMO 回路，也可以独立进行 CRRT 和 ECMO。这篇综述将总结 AKI 的流行病学、CRRT 的适应证和时机、CRRT 的实施以及需要 ECMO 的 CRRT 患者的结局的现有知识。
