From the Guidelines
Extracorporeal treatment refers to a life-support therapy where a patient's blood is temporarily diverted outside the body to a device that performs specific functions, such as oxygenation, filtration, or removal of harmful substances, before being returned to the body, with a notable example being extracorporeal membrane oxygenation (ECMO) as discussed in a recent comprehensive review 1.
Key Aspects of Extracorporeal Treatment
- It involves the use of a device external to the patient's body to support or replace a specific organ function, such as the lungs (via ECMO) or kidneys (via hemodialysis).
- The procedure can be used for various medical conditions, including severe respiratory failure, cardiac failure, and renal failure, as evidenced by the increasing use of ECMO as a rescue therapy 1.
- Extracorporeal treatments are critical for patients with organ failure, allowing for the temporary replacement of vital functions until the underlying condition improves or until a more permanent solution, such as organ transplantation, can be implemented.
Considerations and Complications
- Patients undergoing extracorporeal treatments are at risk for several complications, including bleeding, thrombosis, and infection, highlighting the need for careful patient selection and monitoring 1.
- The risk of acquired von Willebrand syndrome (AVWS) has been identified as a potential contributor to bleeding complications in patients on ECMO, underscoring the importance of understanding the complex interplay between ECMO and coagulopathy 1.
- Systemic anticoagulation is commonly used to prevent clot formation in the ECMO circuit, but this must be balanced against the risk of bleeding, which can have significant mortality implications 1.
Clinical Implications
- The management of patients on extracorporeal treatments requires a multidisciplinary approach, including close monitoring of hemodynamic parameters, coagulation status, and organ function.
- Healthcare professionals must be aware of the potential for AVWS and other complications in patients supported by ECMO, as discussed in recent reviews 1, to provide optimal care and minimize adverse outcomes.
- Further research is needed to fully understand the mechanisms underlying complications associated with extracorporeal treatments and to develop strategies for their prevention and management.
From the Research
Definition and Purpose of Extracorporeal Treatment
- Extracorporeal treatment (ECTR) is a treatment modality that promotes the removal of endogenous or exogenous poisons and supports or temporarily replaces a vital organ 2.
- The purpose of ECTR is to remove toxins from the body, and it has been used for over 50 years in the treatment of poisonings 3.
Principles and Techniques of Extracorporeal Treatment
- The principles that govern poison elimination by ECTR include diffusion, convection, adsorption, and centrifugation 2.
- Different techniques of ECTR are available, including hemodialysis, peritoneal dialysis, and albumin dialysis using the molecular adsorbent recirculating system (MARS) 4.
- High-flux, high-efficiency membranes and albumin dialysis offer possibilities for the removal of protein-bound substances such as diltiazem, phenytoin, and theophylline 4.
Indications and Limitations of Extracorporeal Treatment
- ECTR is indicated for the treatment of certain poisonings, including salicylates, toxic alcohols, and lithium 3.
- The choice of ECTR modality depends on the characteristics of the toxin, such as molecular mass, volume of distribution, and protein binding 3.
- The benefit of ECTR must be weighed against the additive risk of the procedure 3.