Indications for Extracorporeal Therapies

Reviewed and revised 25 June 2012

OVERVIEW

  • Renal Replacement Therapy (CVVDHF)
  • Haemoperfusion
  • ECMO
  • ECCO2
  • Liver dialysis devices
  • Extracorporeal ventricular assist device
  • plasmapheresis/ filtration

INDICATIONS

Renal Replacement Therapy (CVVDHF)

  • Uremia (encephalopathy, pericarditis, urea 30-35 mM)
  • Fluid overload
  • Acidaemia
  • K+ (hyperkalaemia)
  • Extras: hyponatremia, temperature control, toxicants (lithium, metformin, methanol, ethylene glycol, salicylates, theophylline, sodium valproate, methotrexate, procainamide), myoglobin.

Haemoperfusion Therapy

  • barbiturates, e.g. phenobarbitone
  • carbamazepine
  • phenytoin
  • theophylline
  • verapamil

ECMO

  • severe respiratory failure
  • severe cardiac failure

ECCO2

  • severe respiratory failure

Liver Dialysis Devices

  • MARS (molecular adsorbent recirculating system)
  • indications: liver failure (as a bridge to transplantation or resolution of disease process)
  • 2 dialysis circuits: one with albumin so that albumin bound substances are removed (ammonia, bile acids, copper, iron and phenols), the other is used to clean the albumin from the first circuit.

Extracorporeal Ventricular Assist Device

  • temporizing measures to optimize ventricular function while awaiting ventricular function to return
  • as bridging therapy to heart transplantation
  • therapy if not eligible for cardiac transplantation

Plasmapheresis/filtration

  • ITP
  • meningococcal infection
  • hyperviscosity syndromes (leukostasis, MM, sickle cell crisis)
  • immunoglobulins (cryoglobulinaemia, paraproteinaemic polyneuropathies (IgG/IgA))
  • autoantibodies (GBS, CIDP, MG, Goodpastures)
  • circulating immune complexes (immune complex glomerulonephritis, SLE, vasculitis)
  • protein bound substances (thyroid storm, familial hypercholesterolaemia, other poisonings)

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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