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 in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

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

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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