Novel Use of Regional Citrate Anticoagulation for Ultrafiltration Circuit in a Neonate with Severe Ebstein’s Anomaly and Intracranial Hemorrhage - Abstract
Background: Renal Replacement Therapy (RRT), even continuous veno-venous hemofiltration (CVVH), is often not well tolerated in hemodynamically unstable patients. Ultrafiltration (UF) using the Aquadex™ system has emerged as a potential alternative therapy for fluid removal in critically ill pediatric patients. UF, like CVVH, traditionally requires systemic anticoagulation, putting patients at risk for hemorrhage, and precluding its use for fluid removal in patients who have had bleeding complications.
Case: In this report, we present a neonate with complex congenital heart disease, intracranial hemorrhage and acute kidney injury (AKI) who received UF using the AquadexTM system with regional citrate anticoagulation (RCA) instead of the usual unfractionated heparin.
Conclusions: To our knowledge, we describe the first case of the successful use of citrate for anticoagulation for UF using the AquadexTM system. Given that this novel modality for fluid removal is most useful in critically ill children who are commonly at risk for bleeding complications, RCA may prove to be a viable and important alternative to systemic anticoagulation with heparin in this population.