Developing a Protocol for Therapeutic Plasma Exchange in Tandem With Continuous Renal Replacement Therapy (CRRT) and ExtraCorporeal Membrane Oxygenation (ECMO) in Pediatric Patients.

Cyril Jacquot, Maria Di Mola, Reuben Jacob, Gagan Mathur, Cheryl Pacheco, Angelica Vivero, Zachary Corey, Ileana Lopez-Plaza, Kyle Annen

Journal: Journal of clinical apheresis 2025;40(4):e70051

PMID: 40848240

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Abstract

Therapeutic plasma exchange (TPE) in pediatric patients presents many challenges, including management of a large extracorporeal volume (ECV) and calcium replacement for patients who may not be able to express signs of hypocalcemia or other associated adverse events with a large ECV. Pediatric patients who are critically ill on continuous renal replacement therapy (CRRT) and/or extracorporeal membrane oxygenation (ECMO) may have indications for TPE, such as sepsis or liver failure anticipating transplant. It may be difficult or clinically detrimental to take the patient off the CRRT or ECMO circuit to perform TPE. Connecting the TPE device into the preexisting circuit is feasible with the understanding of the principles of the circuit flow set up and monitoring to mitigate adverse events. Effective communication among clinical teams managing distinct extracorporeal circuits is critical to ensuring coordinated patient care.

Address: Department of Laboratory Medicine, Children's National Hospital, Washington, DC, USA.; Departments of Pathology and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.; Sick Kids Hospital Toronto, Toronto, Ontario, Canada.; Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.; Department of Pathology and Laboratory Medicine, University of California-Irvine, Orange, California, USA.; Boston Children's Hospital, Boston, Massachusetts, USA.; Department of Pathology and Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.; Department of Pathology, University of Colorado-Anschutz School of Medicine, California, Aurora, USA.; Department of Pathology and Laboratory Medicine, Henry Ford Health, Detroit, Michigan, USA.; Department of Pathology, University of Colorado-Anschutz School of Medicine, California, Aurora, USA.; Children's Hospital Colorado, Aurora, Colorado, USA.

DOI: 10.1002/jca.70051

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https://doi.org/10.1002/jca.70051

MeSH Terms: Humans, Extracorporeal Membrane Oxygenation, Plasma Exchange, Continuous Renal Replacement Therapy, Child, Renal Replacement Therapy, Clinical Protocols, Hypocalcemia