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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12 maj 2021
O artykule
Kategoria artykułu: Research Article
Data publikacji: 12 maj 2021
Zakres stron: 104 - 112
Otrzymano: 08 paź 2020
Przyjęty: 27 sty 2021
DOI: https://doi.org/10.2478/jccm-2021-0006
Słowa kluczowe
© 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 |