Membrane-based therapeutic plasma exchange in tertiary care ICU: demographic characteristics and predictors of complications

Introduction: Membrane-based therapeutic plasma exchange (mTPE) has been used to treat various diseases in the intensive care unit (ICU) setting. However, there is a lack of clinical data regarding the practice of mTPE from Australian ICUs. 

Objectives: To determine factors contributing to complications in patients undergoing mTPE in the ICU. 

Methods: Prospectively collected data for mTPE procedures performed at the ICU of Flinders Medical Centre between April 2014 and December 2020 were analysed. 

Results: During the study period, 674 mTPE treatments were performed in 140 patients (71 females, 50.7%). Haematological disease (30.4%) was the most common indication for mTPE treatment. Citrate was the most common anticoagulation for mTPE (86.1%), while albumin (42.3%) was the most common replacement fluid. Circuit complications occurred in 18.6% of the total mTPE treatments. On logistical regression analysis, treatment ionised calcium level (odds ratio [OR], 42.2; 95% CI, 1.8–975.0; P = 0.02), male sex (OR, 2.04; 95% CI, 1.04–4; P = 0.04), duration of mTPE treatment (OR, 1.02; 95% CI, 1.01–1.02; P < 0.001) and diagnostic categories (P = 0.03) were predictors of circuit complications. During mTPE treatment, 87.2% of patients did not experience any complications. On logistical regression analysis, replacement fluid type (P = 0.03), lower initial blood flow (OR, 0.9; 95% CI, 0.9–1.0; P = 0.04) and higher exchange volume (OR, 8.9; 95% CI, 1.6–48.7; P = 0.01) were predictors of patient complications. 

Conclusion: During mTPE, pre-treatment ionised calcium level, male sex, duration of mTPE and diagnostic categories were predictors of circuit complications, while replacement fluid type, initial blood flow and higher exchange volume were predictors of patient complications.