{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T08:27:08Z","timestamp":1782289628249,"version":"3.54.5"},"reference-count":38,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T00:00:00Z","timestamp":1615420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Membranes"],"abstract":"<jats:p>The high mortality of pediatric acute respiratory distress syndrome (PARDS) is partly related to fluid overload. Extracorporeal membrane oxygenation (ECMO) is used to treat pediatric patients with severe PARDS, but can result in acute kidney injury (AKI) and worsening fluid overload. The objective of this study was to determine whether the addition of CRRT to ECMO in patients with PARDS is associated with increased mortality. Methods: We conducted a retrospective 7-year study of patients with PARDS requiring ECMO and divided them into those requiring CRRT and those not requiring CRRT. We calculated severity of illness scores, the amount of blood products administered to both groups, and determined the impact of CRRT on mortality and morbidity. Results: We found no significant difference in severity of illness scores except the vasoactive inotropic score (VIS, 45 \u00b1 71 vs. 139 \u00b1 251, p = 0.042), which was significantly elevated during the initiation and the first three days of ECMO. CRRT was associated with an increase in the use of blood products and noradrenaline (p &lt; 0.01) without changing ECMO duration, length of PICU stay or mortality. Conclusion: The addition of CRRT to ECMO is associated with a greater consumption of blood products but no increase in mortality.<\/jats:p>","DOI":"10.3390\/membranes11030195","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T20:17:40Z","timestamp":1615493860000},"page":"195","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of CRRT in Patients with PARDS Treated with VV-ECMO"],"prefix":"10.3390","volume":"11","author":[{"given":"S\u00e9bastien","family":"Redant","sequence":"first","affiliation":[{"name":"Departments of Intensive Care, Brugmann University Hospital, 1020 Brussels, Belgium"},{"name":"Departments of Intensive Care, Hospital Universitaire des Enfants Reine Fabiola (HUDERF), 1020 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oc\u00e9ane","family":"Barbance","sequence":"additional","affiliation":[{"name":"Departments of Intensive Care, Brugmann University Hospital, 1020 Brussels, Belgium"},{"name":"Departments of Intensive Care, Hospital Universitaire des Enfants Reine Fabiola (HUDERF), 1020 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashita","family":"Tolwani","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Beretta-Piccoli","sequence":"additional","affiliation":[{"name":"Departments of Intensive Care, Hospital Universitaire des Enfants Reine Fabiola (HUDERF), 1020 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Massaut","sequence":"additional","affiliation":[{"name":"Departments of Intensive Care, Brugmann University Hospital, 1020 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"De Bels","sequence":"additional","affiliation":[{"name":"Departments of Intensive Care, Brugmann University Hospital, 1020 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio S.","family":"Taccone","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Hopital Erasme, Universit\u00e9 Libre de Bruxelles, 1020 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick M.","family":"Honor\u00e9","sequence":"additional","affiliation":[{"name":"Departments of Intensive Care, Brugmann University Hospital, 1020 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Biarent","sequence":"additional","affiliation":[{"name":"Departments of Intensive Care, Hospital Universitaire des Enfants Reine Fabiola (HUDERF), 1020 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1542\/peds.2007-2462","article-title":"Incidence and outcomes of pediatric acute lung injury","volume":"124","author":"Zimmerman","year":"2009","journal-title":"Pediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S2213-2600(18)30344-8","article-title":"Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): An international, observational study","volume":"7","author":"Khemani","year":"2019","journal-title":"Lancet Respir. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"718","DOI":"10.4187\/respcare.05591","article-title":"Pediatric ARDS","volume":"62","author":"Cheifetz","year":"2017","journal-title":"Respir. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"455","DOI":"10.21037\/atm.2018.11.12","article-title":"Retrospective study on the effects of the prognosis of patients treated with extracorporeal membrane oxygenation combined with continuous renal replacement therapy","volume":"6","author":"He","year":"2018","journal-title":"Ann. Transl. Med."},{"key":"ref_5","first-page":"854142","article-title":"Positive fluid balance is associated with higher mortality and prolonged mechanical ventilation in pediatric patients with acute lung injury","volume":"2011","author":"Flori","year":"2011","journal-title":"Crit. Care Res. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2883","DOI":"10.1097\/CCM.0b013e31825bc54d","article-title":"Fluid balance in critically ill children with acute lung injury","volume":"40","author":"Valentine","year":"2012","journal-title":"Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1016\/0022-3468(92)90547-K","article-title":"Extracellular fluid and total body water changes in neonates undergoing extracorporeal membrane oxygenation","volume":"27","author":"Anderson","year":"1992","journal-title":"J. Pediatr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1007\/s00467-008-1047-z","article-title":"Significance of hemolysis on extracorporeal life support after cardiac surgery in children","volume":"24","author":"Gbadegesin","year":"2009","journal-title":"Pediatr. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1007\/s00134-011-2231-3","article-title":"Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy","volume":"37","author":"Selewski","year":"2011","journal-title":"Intensive Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1053\/j.ajkd.2009.10.048","article-title":"Fluid overload and mortality in children receiving continuous renal replacement therapy: The prospective pediatric continuous renal replacement therapy registry","volume":"55","author":"Sutherland","year":"2010","journal-title":"Am. J. Kidney Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1007\/s00134-014-3360-2","article-title":"Impact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation","volume":"40","author":"Schmidt","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_12","unstructured":"Extracorporeal Life Support Organizatio (2021, March 07). ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support Version 1.4. Available online: https:\/\/www.elso.org\/Portals\/0\/ELSO%20Guidelines%20General%20All%20ECLS%20Version%201_4.pdf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.2215\/CJN.12731211","article-title":"Renal replacement therapy in critically ill patients receiving extracorporeal membrane oxygenation","volume":"7","author":"Askenazi","year":"2012","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1203\/PDR.0b013e3181e4c9f8","article-title":"Extracorporeal membrane oxygenation causes loss of intestinal epithelial barrier in the newborn piglet","volume":"68","author":"Kurundkar","year":"2010","journal-title":"Pediatr. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1159\/000087630","article-title":"Cytokine imbalance in infants receiving extracorporeal membrane oxygenation for respiratory failure","volume":"88","author":"Mildner","year":"2005","journal-title":"Biol. Neonate"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/S0022-3476(96)70252-4","article-title":"Activation of the clotting system during extracorporeal membrane oxygenation in term newborn infants","volume":"129","author":"Urlesberger","year":"1996","journal-title":"J. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2350\/09-09-0704-OA.1","article-title":"Laboratory and clinical predictors of thrombosis and hemorrhage in 29 pediatric extracorporeal membrane oxygenation nonsurvivors","volume":"13","author":"Reed","year":"2010","journal-title":"Pediatr. Dev. Pathol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1186\/s13054-015-0860-6","article-title":"Intertwining extracorporeal membrane oxygenation and continuous renal replacement therapy: Sense or nonsense?","volume":"19","author":"Jacobs","year":"2015","journal-title":"Crit. Care"},{"key":"ref_19","first-page":"378","article-title":"Enhanced hemolysis in pediatric patients requiring extracorporeal membrane oxygenation and continuous renal replacement therapy","volume":"13","author":"Betrus","year":"2007","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1097\/CCM.0000000000001141","article-title":"Impact of Acute Kidney Injury on Outcome in Patients With Severe Acute Respiratory Failure Receiving Extracorporeal Membrane Oxygenation","volume":"43","author":"Haneya","year":"2015","journal-title":"Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/MAT.0b013e3182579218","article-title":"A multicenter international survey of renal supportive therapy during ECMO: The Kidney Intervention During Extracorporeal Membrane Oxygenation (KIDMO) group","volume":"58","author":"Fleming","year":"2012","journal-title":"ASAIO J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1111\/aor.12695","article-title":"The Impact of Renal Failure and Renal Replacement Therapy on Outcome During Extracorporeal Membrane Oxygenation Therapy","volume":"40","author":"Antonucci","year":"2016","journal-title":"Artif. Organs"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.1097\/CCM.0000000000002019","article-title":"Development and Validation of a Score to Predict Mortality in Children Undergoing Extracorporeal Membrane Oxygenation for Respiratory Failure: Pediatric Pulmonary Rescue With Extracorporeal Membrane Oxygenation Prediction Score","volume":"45","author":"Bailly","year":"2017","journal-title":"Crit. Care Med."},{"key":"ref_24","unstructured":"(2021, March 07). KDIGO Clinical Practice Guideline for Acute Kidney Injury. Available online: https:\/\/kdigo.org\/wp-content\/uploads\/2016\/10\/KDIGO-2012-AKI-Guideline-English.pdf."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e671","DOI":"10.1542\/peds.111.6.e671","article-title":"Neurodevelopmental outcome of infants supported with extracorporeal membrane oxygenation after cardiac surgery","volume":"111","author":"Hamrick","year":"2003","journal-title":"Pediatrics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1016\/S0003-4975(03)00898-1","article-title":"Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery","volume":"76","author":"Kolovos","year":"2003","journal-title":"Ann. Thorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1097\/PCC.0b013e3181fe4717","article-title":"Neutrophil gelatinase-associated lipocalin levels during extracorporeal membrane oxygenation in critically ill children with congenital heart disease: Preliminary experience","volume":"13","author":"Ricci","year":"2012","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1016\/j.athoracsur.2013.05.056","article-title":"Early renal replacement therapy during pediatric cardiac extracorporeal support increases mortality","volume":"96","author":"Wolf","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"R73","DOI":"10.1186\/cc12681","article-title":"Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: A 5-year cohort study","volume":"17","author":"Aubron","year":"2013","journal-title":"Crit. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1097\/PCC.0000000000000290","article-title":"Hemofiltration is not associated with increased mortality in children receiving extracorporeal membrane oxygenation","volume":"16","author":"Lou","year":"2015","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1093\/ndt\/gfv454","article-title":"An estimated glomerular filtration rate equation for the full age spectrum","volume":"31","author":"Pottel","year":"2016","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"R278","DOI":"10.1186\/cc13133","article-title":"Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: A retrospective observational study","volume":"17","author":"Legrand","year":"2013","journal-title":"Crit. Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s00467-018-4047-7","article-title":"Hemodynamic impact of the connection to continuous renal replacement therapy in critically ill children","volume":"34","author":"Fernandez","year":"2019","journal-title":"Pediatr. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1111\/hdi.12760","article-title":"Continuous renal replacement therapy is associated with acute cardiac stunning in critically ill patients","volume":"23","author":"Slessarev","year":"2019","journal-title":"Hemodial. Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1007\/s11255-017-1589-8","article-title":"Unexpected and striking effect of heparin-free dialysis on cytokine release","volume":"49","author":"Borawski","year":"2017","journal-title":"Int. Urol. Nephrol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Jeney, V. (2018). Pro-Inflammatory Actions of Red Blood Cell-Derived DAMPs. Experientia Supplementum, Springer International Publishing.","DOI":"10.1007\/978-3-319-89390-7_9"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1161\/CIRCRESAHA.116.309726","article-title":"Purinergic Signaling in the Cardiovascular System","volume":"120","author":"Burnstock","year":"2017","journal-title":"Circ. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/PCC.0b013e3181d8e348","article-title":"Acute kidney injury and renal replacement therapy independently predict mortality in neonatal and pediatric noncardiac patients on extracorporeal membrane oxygenation","volume":"12","author":"Askenazi","year":"2011","journal-title":"Pediatr. Crit. Care Med."}],"container-title":["Membranes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0375\/11\/3\/195\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:34:20Z","timestamp":1760160860000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0375\/11\/3\/195"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,11]]},"references-count":38,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["membranes11030195"],"URL":"https:\/\/doi.org\/10.3390\/membranes11030195","relation":{},"ISSN":["2077-0375"],"issn-type":[{"value":"2077-0375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,11]]}}}