Journal of Artificial Organs

, Volume 22, Issue 4, pp 286–293 | Cite as

Early continuous renal replacement therapy during infant extracorporeal life support is associated with decreased lung opacification

  • Heidi J. MurphyEmail author
  • Meryle J. Eklund
  • Jeanne Hill
  • Kristen Morella
  • John B. Cahill
  • James R. Kiger
  • Katherine E. Twombley
  • David J. AnnibaleEmail author
Original Article Artificial Lung / ECMO


Lung opacification on chest radiography (CXR) is common during extracorporeal life support (ECLS), often resulting from pulmonary edema or inflammation. Concurrent use of continuous renal replacement therapy (CRRT) during ECLS is associated with improved fluid balance and cytokine filtration; through modification of these pathologic states, CRRT may modulate lung opacification observed on CXRs. We hypothesize that early CRRT use during infant ECLS decreases lung opacification on CXR. We conducted a retrospective cohort study comparing CXRs from infants receiving ECLS and early CRRT (n = 7) to matched infants who received ECLS alone (n = 7). The CXR obtained prior to ECLS, all CXRs obtained within the first 72 h of ECLS, and daily CXRs for the remainder of the ECLS course were analyzed. The outcome measure was the degree of opacification, determined by independent assessment of two, blinded pediatric radiologists using a modified Edwards et al.’s lung opacification scoring system (from Score 0: no opacification to Score 5: complete opacification). 220 CXRs were assessed (cases: 93, controls: 127). Inter-rater reliability was established (Cohen’s weighted к = 0.74; p < 0.0001, good agreement). At baseline, the mean opacification score difference between cases and controls was 1 point (cases: 1.8, controls 2.8; p = 0.049). Using mixed modeling analysis for repeated measures accounting for differences at baseline, the average overall opacification score was 1.2 points lower in cases than controls (cases: 2.1, controls: 3.3; p < 0.0001). The overall distribution of scores was lower in cases than controls. Early CRRT utilization during infant ECLS was associated with decreased lung opacification on CXR.


Extracorporeal life support Extracorporeal membrane oxygenation Continuous renal replacement therapy Renal support therapy Lung opacification 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© The Japanese Society for Artificial Organs 2019

Authors and Affiliations

  1. 1.Department of PediatricsMedical University of South CarolinaCharlestonUSA
  2. 2.Department of Radiology and Radiological ScienceMedical University of South CarolinaCharlestonUSA
  3. 3.Department of Public Health SciencesMedical University of South CarolinaCharlestonUSA
  4. 4.Department of PediatricsUniversity of PittsburghPittsburghUSA
  5. 5.Division of NeonatologyMedical University of South CarolinaCharlestonUSA

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