【体外膜肺ECMO精品课件】 Haemofiltration in newborns treated with extracorporeal membrane oxygenation.ppt

Haemofiltration in newborns treated with extracorporeal membrane oxygenation a case-comparison study Karin Blijdorp, research student Karlien Cransberg, pediatric nephrologist Erasmus MC Sophia, Rotterdam, The Netherlands ECMO treatment in The Netherlands since 1994, in 2 centers University Medical Center, Nijmegen Erasmus MC Sophia, Rotterdam: 40 ECMO runs yearly Indication: acute reversible cardiovascular or respiratory failure with an expected mortality of 80%: congenital diaphragmatic hernia meconium aspiration syndrome other Systemic inflammatory response syndrome due to primary disease and/or ECMO system: generalised edema by capillary leakage low blood pressure multi-organ failure prior investigations: hemofiltration added to cardiopulmonary bypass: less SIRS less pulmonary edema with shorter assisted ventilation time improved cardiac function Huang et al, Ann Thorac Surg 2003 Journois et al,Anesthesiology 1994 Journois et al, Anesthesiology 1996 Rivera et al, J Am Coll Cardiol 1998 Davies et al, J Thorac Cardiovasc Surg 1998 Aim of the study Clinical outcome of ECMO treated infants with haemofiltration compared to without. Primary endpoints: Duration of ECMO Duration of assisted ventilation after weaning from ECMO Secondary endpoints: Mortality Fluid balance Vasopressorscore Maximal serum creatinine Transfusion red blood cells platelets Costs Methods Retrospective case-comparison study 1:3 Cohort 2004-2006: with hemofiltration (n=15) Inclusion: age 30 days Exclusion: co-treatment with diuretics start hemofiltration 3 hrs after start ECMO Cohort 2002-2004: control group without hemofiltration (n=45) Matched for age, weight, diagnosis and mode of ECMO Haemofiltration in ECMO circuit ECMO-pump clamp Haemofiltration in ECMO circuit ECMO-pump clamp heparin substitution fluid Pressure gradient over haemofilter of 40 mmHg Methods: hemofiltration Filter: Multiflow 100, AN 69 Filtration: