Key result
An automated regional citrate anticoagulation system accurately measured ionized calcium and successfully regulated calcium and citrate infusion rates in a closed-loop model.
Why the study?
Regional citrate anticoagulation is complex and requires maintaining ionized calcium in a targeted range, motivating the development of an automated system using online monitoring and closed-loop feedback.
Does an automated regional citrate anticoagulation system based on online monitoring accurately measure and maintain ionized calcium concentrations in vitro and in vivo?
Does an automated regional citrate anticoagulation system based on online monitoring accurately measure and maintain ionized calcium concentrations in vitro and in vivo?
An automated regional citrate anticoagulation system using online ionized calcium monitoring and closed-loop feedback is feasible and accurately maintains target calcium levels in proof-of-concept testing.
Preclinical feasibility shown in animals; leaves open clinical validation for automated regional citrate anticoagulation.
BACKGROUND: Regional citrate anticoagulation (RCA), a complex and effective technique, is recommended as the anticoagulation of choice for continuous renal replacement therapy. One of its key objectives is to keep the ionized calcium in the targeted range. In this study, we aimed to develop an automated RCA based on online monitoring of the ionized calcium concentration and closed-loop feedback. METHODS: We constructed calcium-selective electrodes with liquid inner contact, which measured a potentiometric signal as the output. We tested the responses, stability, and selectivity of the electrodes in flowing fluid containing calcium chloride. We compared the measurement accuracy between the electrodes and an i-STAT system in vivo. Moreover, we established closed-loop feedback using a proportional-integral-derivative controller model. We performed simulated automated RCA both in vivo and in vitro. RESULTS: did not interfere with the measurements of ionized calcium. These measurements in whole blood by the electrode were very close to those assessed by the i-STAT system. The feedback control system responded quickly to an abnormal ionized calcium concentration and regulated the infusion rates of calcium or citrate to maintain the concentration of ionized calcium within the targeted range. CONCLUSIONS: We successfully trialed automated RCA, which may help simplify the complexities of RCA in the future.
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Bi et al. (2022) studied Continuous renal replacement therapy. Automated regional citrate anticoagulation with closed-loop feedback vs. i-STAT system (for measurement accuracy) was evaluated on Measurement accuracy of ionized calcium and feedback control response. An automated regional citrate anticoagulation system accurately measured ionized calcium and successfully regulated calcium and citrate infusion rates in a closed-loop model.
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