Case Reports

Aquapheresis (AQ) in Tandem with Extracorporeal Membrane Oxygenation (ECMO) in Pediatric Patients

^* Department of Pediatric Nephrology
^† Department of Pediatric Critical Care, and
^‡ Department of Pediatric Cardiac Surgery, Joe DiMaggio Children’s Hospital, Hollywood, Florida
^§ Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, Florida; and
^¶ Kiran C. Patel College of Allopathic Medicine at Nova Southeastern University, Ft. Lauderdale, Florida

Address correspondence to: Alex Constantinescu, MD, Chief, Pediatric Nephrology Joe DiMaggio Children’s Hospital, 1131 N35th Avenue, Second Floor, Hollywood, FL 33021. E-mail: aconstantinescu@mhs.net

Received: 11 March 2019
Accepted: 2 June 2019

Abstract

Children with cardiopulmonary failure requiring extracorporeal membrane oxygenation (ECMO) are at risk for fluid overload (FO) despite the normal estimated glomerular filtration rate (eGFR). It has been shown that survival in the intensive care unit (ICU) is inversely proportional to FO. Therefore, fluid removal, or prevention of FO, in these critical cases has the potential to improve survival. Aquapheresis (AQ), a procedure used for fluid removal, with success in patients with heart failure has also been used in children with acute oliguric kidney injury (AKI), to prevent and treat FO. The purpose of this article was to describe the use of Aquadex FlexFlow^® for AQ in pediatric patients on ECMO, as a means to provide a simplified and safe form of fluid removal with minimal impact on ECMO therapy. The principal variables collected include patients’ demographics, urine output, serum creatinine, withdrawal and infusion pressures, ultrafiltration (UF) rates, and ECMO flow ranges, along with length of stay in pediatric ICU and survival. Patient survival was 100% with preserved eGFR. The ECMO flows were not affected by AQ. Urine output decreased somewhat during therapy, with little AQ machine pressure variations. Range of UF tolerated without hemodynamic abnormalities was 1.24–6.2 mL/kg/h, allowing the patients to maintain their pre-AQ body weight, while receiving intravenous (IV) nutrition and medications. This article describes the use of AQ in tandem with ECMO in a user-friendly and safe way to provide UF in children requiring cardiopulmonary support, with minimal flow and hemodynamic disturbance.