Extracorporeal Therapies (ECT)
Bridgetown Veterinary Emergency and Referral is excited to announce the launch of our Extracorporeal Therapies (ECT) Department, expanding our ability to provide advanced, lifesaving care for critically ill patients.
Our ECT service is overseen by our very own Dr. Julia VanDerslice. Following her residency in Emergency and Critical Care Medicine at Angell Animal Medical Center in Massachusetts, Dr. VanDerslice went on to complete a year fellowship in Extracorporeal Therapy at North Carolina State University.
Bridgetown will start by offering Hemoperfusion with upcoming plans to incorporate Total Plasma Exchange and CRRT in the near future.
Hemoperfusion (HP)
What Is Hemoperfusion?
Hemoperfusion is a blood purification therapy in which blood is passed through an adsorptive column containing activated carbon or polymer beads. Hemoperfusion removes substances by directly binding them to the beads inside the column.
Hemoperfusion is a newer modality in veterinary medicine but has a growing body of literature supporting its use, particularly for drug overdoses.
Indications for Hemoperfusion
Hemoperfusion is most commonly used for:
- NSAID (carprofen, meloxicam, ibuprofen, naproxen)
- Xylitol
- Antidepressants (fluoxetine, sertraline)
- Phenobarbital
- Baclofen
- Rodenticides
In addition to toxin removal, hemoperfusion may reduce inflammatory mediators, bilirubin, and cellular breakdown products, making it a potential adjunctive therapy for inflammatory conditions such as immune mediated diseases, sepsis, SIRS, and heat stroke.
Hemoperfusion can be performed:
- As a stand-alone therapy
- In combination with hemodialysis
- In conjunction with other treatments such as intravenous lipid emulsion
Therapeutic Plasma Exchange (TPE)
What Is Therapeutic Plasma Exchange?
Therapeutic plasma exchange involves removal of the patient’s plasma and replacement with donor plasma or other fluids. This allows for the elimination of large molecules that are not effectively removed by dialysis or hemoperfusion.
Indications for Therapeutic Plasma Exchange
Toxicities
- NSAID overdoses (most reported extracorporeal therapy is for NSAID ingestion)
- Alcohol
- Caffeine
- Phenobarbital
- Ethylene glycol (antifreeze)
- Baclofen
- Chemotherapeutic overdoses
Immune-Mediated Disease
- Immune-mediated hemolytic anemia (IMHA)
- Immune-mediated thrombocytopenia (ITP)
- Myasthenia gravis
- Glomerulonephritis (Lyme Nephritis)
- Polyradiculoneuritis (Coonhound Paralysis)
- Other severe autoimmune diseases
Endogenous Toxins
- Severe hyperbilirubinemia, which may contribute to neurologic signs and renal injury
- Hepatic encephalopathy
Continuous Renal Replacement Therapy (CRRT)
What Is Continuous Renal Replacement Therapy?
Continuous Renal Replacement Therapy (CRRT) is an advanced, continuous form of dialysis used in critically ill pets. Blood is slowly circulated through a specialized machine that filters out waste products, excess fluid, and corrects electrolyte and acid–base imbalances. Because it runs 24 hours a day, CRRT provides gentle, steady support and is better tolerated by unstable patients than traditional intermittent dialysis.
Indications for Continuous Renal Replacement Therapy
- Acute Kidney Injury (AKI)
- Decreased or absent urine production (oliguria/anuria)
- Severe infections with kidney involvement
- Fluid Overload
- Severe Electrolyte and Acid–Base imbalances not responding to treatment
- Selected poisonings when continuous, gentle toxin removal is preferred
- Cases where the patient is too unstable for intermittent dialysis
Hemodialysis (HD)
What Is Hemodialysis?
Hemodialysis is a therapy in which blood is passed through a dialyzer containing a semi-permeable membrane. Small molecules move across the membrane, allowing removal of waste products, toxins, excess electrolytes, and fluid.
Hemodialysis functions as an artificial kidney and is a cornerstone therapy for patients with acute kidney injury or for treatment of select toxicities.
Indications for Hemodialysis
Toxicities
- Ethylene glycol
- Ivermectin
- Metaldehyde
- Phenobarbital
- Baclofen
Non-toxicity Indications
- Acute kidney injury
- Severe azotemia or uremia
- Refractory electrolyte abnormalities
- Fluid overload unresponsive to medical management
If you are worried that your pet may be suffering from a medical emergency, please call us!
503-489-9535
Extracorporeal Therapies (ECT) in Veterinary Medicine
Extracorporeal therapies (ECT) are advanced blood purification medical treatments that remove harmful substances directly from a patient’s blood by passing it through specialized filters outside the body. These therapies are used when traditional medical management alone is inadequate to treat the disease process or when endogenous clearance could result in serious or irreversible organ damage.
ECTs are most commonly used in veterinary medicine for:
- Acute kidney injury (Hemodialysis; HD, CRRT)
- Autoimmune and immune-mediated disease (Therapeutic Plasma Exchange; TPE)
- Drug overdoses and toxicities (Hemoperfusion, HD, CRRT, and/or TPE)
- Fluid overload (HD, CRRT)
Forms of Extracorporeal Therapy
The four primary extracorporeal therapy modalities used in veterinary medicine are:
- Hemoperfusion (HP)
- Continuous Renal Replacement Therapy (CRRT)
- Therapeutic Plasma Exchange (TPE)
- Hemodialysis (HD)
Each modality removes substances from the blood using different mechanisms, and the choice of therapy depends on the characteristics of the toxin or disease process as well as patient-specific factors.
Timing and Prognosis
- Early referrals are critical for optimal outcomes.
- Initial decontamination (emesis, activated charcoal) should be performed when appropriate prior to referral.
- Ideal candidates are treated within 24 hours or less of exposure, sooner if possible.
- Prognosis for many toxicities, particularly NSAID overdoses, is excellent when treated promptly with extracorporeal therapy.
Risks and Monitoring
Extracorporeal therapies are generally safe and well tolerated.
Potential risks include:
- Thrombocytopenia
- Bleeding related to anticoagulation
- Catheter-associated complications
- Sedation or anesthesia-related risks
- Incomplete response to therapy
Patients are monitored closely during treatment and hospitalized in the ICU following therapy.
Consultation and Referral
Not all toxicities or disease processes are appropriate for extracorporeal therapies. Each case is evaluated individually, and consultation with the Extracorporeal Therapy Service is recommended for any suspected ingestion or complex medical condition.
Early consultation and referral are strongly encouraged, as outcomes are often optimized when therapy is initiated as soon as possible after exposure or disease onset.
AVOID USING THE JUGULAR VEINS IN ANY POTENTIAL CANDIDATE FOR EXTRACORPOREAL THERAPIES. Due to the size of our patients in veterinary medicine, the jugular veins are used for vascular access and must be protected to optimize conditions for catheter placement.
To discuss any potential case, please reach out to Bridgetown Veterinary Emergency and Referral at any hour of the day. You will be connected to a Critical Care Specialist, Internal Medicine Specialist or Emergency Veterinarian and we will help guide you through the referral process.
Julia VanDerslice, DVM, DACVECC is readily available to speak with referring veterinarians on prospective cases.