Renal Recovery in Critically Ill Adult Patients Treated With Veno-Venous or Veno-Arterial Extra Corporeal Membrane Oxygenation: A Retrospective Cohort Analysis
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May 12, 2021
About this article
Article Category: Research Article
Published Online: May 12, 2021
Page range: 104 - 112
Received: Oct 08, 2020
Accepted: Jan 27, 2021
DOI: https://doi.org/10.2478/jccm-2021-0006
Keywords
© 2021 Braghadheeswar Thyagarajan, Mariana Murea, Deanna N. Jones, Amit K. Saha, Gregory B. Russell, Ashish K. Khanna, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Fig.1
Fig. 2
Distribution of Acute Kidney Injury Risk Factors
| Factor | VA ECMO | VV ECMO | Odds Ratio of AKI (95% CI) | p-value |
|---|---|---|---|---|
| IV contrast scan (%) | 37 (64%) | 33 (65%) | 0.96 (0.44, 2.11) | 0.92 |
| Cardiopulmonary Bypass (%) | 14 (24%) | 1 (2%) | 15.9 (2.0, 125.9) | 0.0088 |
| NSAID (%) | 9 (16%) | 15 (29%) | 0.44 (0.17, 1.12) | 0.085 |
| Antibiotics (%) | 32 (55%) | 29 (57%) | 0.93 (0.44, 1.99) | 0.86 |
| Sepsis (%) | 5 (9%) | 12 (24%) | 0.31 (0.10, 0.94) | 0.039 |
| Hypotension (%) | 49 (84%) | 35 (69%) | 2.49 (0.99, 6.28) | 0.053 |
| Vasopressor dependent Hypotension (%) | 38 (66%) | 31 (61%) | 1.23 (0.56, 2.68) | 0.61 |
| CHF (%) | 14 (24%) | 10 (20%) | 1.31 (0.52, 3.26) | 0.57 |
Renal Outcomes by Type of ECMO Support
| VA ECMO | VV ECMO | p-value | |
|---|---|---|---|
| Complete Renal Recovery | 15 (26%) | 22 (43%) | 0.07 |
| Partial Renal Recovery | 5 (9%) | 3 (6%) | 0.72 |
| Dialysis Dependent | 1 (2%) | 1 (2%) | >0.99 |
| Death | 37 (64%) | 25 (49%) | 0.13 |
Primary Diagnosis of VA and VV ECMO groups
| Primary Diagnosis | VA ECMO | VV ECMO |
|---|---|---|
| Acute Coronary Syndrome | 27 | 0 |
| Congestive heart failure | 9 | 0 |
| Sepsis | 5 | 12 |
| Cardiac arrest | 5 | 0 |
| Valvular heart disease | 4 | 0 |
| Pulmonary embolism | 3 | 0 |
| Cardiac arrhythmias | 3 | 0 |
| Others | 8 | 15 |
| Pneumonia | 0 | 10 |
| Trauma | 0 | 10 |
| Viral Pneumonia | 0 | 5 |
| Drug Overdose | 0 | 3 |
| Acute Pancreatitis | 0 | 2 |
| Asthma | 0 | 1 |
Baseline Patient Characteristics by Type of ECMO Support
| VA ECMO | VV ECMO | p-Value | |
|---|---|---|---|
| Total Number | 64 | 58 | |
| Age, mean (SD), years | 55.4 (15.8) | 42.9 (16.2) | <0.0001 |
| Male sex, n (%) | 50 (78%) | 40 (70%) | 0.21 |
| White race, n (%) | 46 (79%) | 36 (71%) | 0.37 |
| BMI, mean (SD) | 32.9 (9.0) | 30.4 (8.1) | 0.30 |
| Smoking – No | 59 (92%) | 49 (84%) | 0.26 |
| Diabetes mellitus, n (%) | 4 (6%) | 6 (10%) | 0.52 |
| CAD, n (%) | 14 (22%) | 4 (7%) | 0.023 |
| HTN, n (%) | 16 (25%) | 15 (26%) | >0.99 |
| CKD, n (%) | 10 (16%) | 3 (5%) | 0.080 |
| Hyperlipidaemia, n (%) | 14 (22%) | 5 (9%) | 0.049 |
| COPD, n (%) | 7 (11%) | 6 (10%) | >0.99 |
| APACHE II, mean (SD) | 24.8 (7.9) | 28.0 (6.2) | 0.014 |
| Charlson Comorbidity Index, mean (SD) | 2.4 (2.7) | 1.8 (3.0) | 0.27 |
| Lactic acid, mean (SD), mmol/L | 7.4 (4.4) | 4.4 (3.2) | 0.0002 |
| ICU length of stay, mean (SD), days | 11.6 (10.8) | 24.5 (15.4) | <0.0001 |
| AKI, all stage, n (%) | 58 (91%) | 51 (88%) | 0.77 |