Factors associated with major adverse kidney events in patients who underwent veno-arterial extracorporeal membrane oxygenation

Vinclair, Camille; Montmollin, Étienne de; Sonneville, Romain; Reuter, Jean; Lebut, Jordane; Cally, Radj; Mourvillier, Bruno; Neuville, Mathilde; Ruckly, Stéphane; Timsit, Jean‐François; Bouadma, Lila

doi:10.1186/s13613-020-00656-w

Cited by 24 publications

(24 citation statements)

References 28 publications

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“…Similar results have been reported for lactate as a surrogate for tissue hypoperfusion, which remains high in some patients despite VA-ECMO [ 21 ]. The frequent development of end-organ failure including acute kidney injury in patients on VA-ECMO [ 22 , 23 ], further suggests insufficient end-organ perfusion in some patients. We show that, compared to patients with cerebral damage, patients with persistent shock were older, more frequently underwent in-hospital cardiac arrest, and had shorter low-flow durations.…”

Section: Discussionmentioning

confidence: 99%

Mode of Death after Extracorporeal Cardiopulmonary Resuscitation

et al. 2021

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Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) might be a lifesaving therapy for patients with cardiac arrest and no return of spontaneous circulation during advanced life support. However, even with ECPR, mortality of these severely sick patients is high. Little is known on the exact mode of death in these patients. Methods: Retrospective registry analysis of all consecutive patients undergoing ECPR between May 2011 and May 2020 at a single center. Mode of death was judged by two researchers. Results: A total of 274 ECPR cases were included (age 60.0 years, 47.1% shockable initial rhythm, median time-to-extracorporeal membrane oxygenation (ECMO) 53.8min, hospital survival 25.9%). The 71 survivors had shorter time-to-ECMO durations (46.0 ± 27.9 vs. 56.6 ± 28.8min, p < 0.01), lower initial lactate levels (7.9 ± 4.5 vs. 11.6 ± 8.4 mg/dL, p < 0.01), higher PREDICT-6h (41.7 ± 17.0% vs. 25.3 ± 19.0%, p < 0.01), and SAVE (0.4 ± 4.8 vs. −0.8 ± 4.4, p < 0.01) scores. Most common mode of death in 203 deceased patients was therapy resistant shock in 105/203 (51.7%) and anoxic brain injury in 69/203 (34.0%). Comparing patients deceased with shock to those with cerebral damage, patients with shock were significantly older (63.2 ± 11.5 vs. 54.3 ± 16.5 years, p < 0.01), more frequently resuscitated in-hospital (64.4% vs. 29.9%, p < 0.01) and had shorter time-to-ECMO durations (52.3 ± 26.8 vs. 69.3 ± 29.1min p < 0.01). Conclusions: Most patients after ECPR decease due to refractory shock. Older patients with in-hospital cardiac arrest might be prone to development of refractory shock. Only a minority die from cerebral damage. Research should focus on preventing post-CPR shock and treating the shock in these patients.

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Section: Discussionmentioning

confidence: 99%

Mode of Death after Extracorporeal Cardiopulmonary Resuscitation

et al. 2021

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“…On the other hand, AKI patients with RRT initiation after ECMO could well represent a different population phenotype, which intravascular hemolysis secondary to the extracorporeal circuit plays a more central role in the pathophysiology of AKI. Findings from the French study of an association between MAKE at 1 year and the number of RBC packs received while on ECMO align with this theory (15). The other possibility is that early initiation of RRT in patients with severe cardiac or respiratory failure who require ECMO is associated with favorable long-term renal outcomes.…”

Section: Discussionmentioning

confidence: 60%

“…Despite these major differences in study design, the Taiwanese study results seem consistent with our findings. In a single-center study from France, Vinclair et al (15) examined factors associated with MAKE in a cohort of patients requiring venoarterial ECMO (VA-ECMO). Interestingly, this study found that baseline eGFR, KDIGO AKI stage at ECMO cannulation, and the number of RBC packs received while on ECMO were associated with MAKE at 1 year.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Major Adverse Kidney Events in Extracorporeal Membrane Oxygenation Survivors

Bobba

Costanian

Bahous

et al. 2022

Critical Care Explorations

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“…All three patients with AKI underwent mechanical ventilation and ECMO, and it was difficult to distinguish whether AKI was caused by SARS-CoV-2 infection or was associated with treatments, such as ECMO and vancomycin. 24 25 Therefore, it is possible that the incidence of AKI related to COVID-19 was overestimated. In fact, all three patients used both ECMO and vancomycin, and AKI developed after vancomycin use.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury and Kidney Damage in COVID-19 Patients

Kim

Ham

et al. 2020

J Korean Med Sci

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Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This disease, which is quickly spreading worldwide, has high potential for infection and causes rapid progression of lung lesions, resulting in a high mortality rate. This study aimed to investigate the effects of SARS-CoV-2 infection on renal function in patients with COVID-19. Methods: From February 21 to April 24, 2020, 66 patients diagnosed with COVID-19 at Chungnam National University Hospital were analyzed; all patients underwent routine urinalysis and were tested for serum creatinine, urine protein to creatinine ratio (PCR), and urine albumin to creatinine ratio (ACR). Results: Acute kidney injury (AKI) occurred in 3 (4.5%) of the 66 patients, and 1 patient with AKI stage 3 underwent hemodialysis. Upon follow-up, all 3 patients recovered normal renal function. Compared with patients with mild COVID-19, AKI (n = 3) occurred in patients with severe COVID-19, of whom both urine PCR and ACR were markedly increased. Conclusion: The incidence of AKI was not high in COVID-19 patients. The lower mortality rate in SARS-CoV-2 infection compared with previous Middle East respiratory syndrome and SARS-CoV infections is thought to be associated with a low incidence of dysfunction in organs other than the lungs.

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Factors associated with major adverse kidney events in patients who underwent veno-arterial extracorporeal membrane oxygenation

Abstract: Objective: To describe acute kidney injury (AKI) natural history and to identify predictors of major adverse kidney events (MAKE) within 1 year in patients supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

Cited by 24 publications

References 28 publications

Mode of Death after Extracorporeal Cardiopulmonary Resuscitation

Mode of Death after Extracorporeal Cardiopulmonary Resuscitation

Determinants of Major Adverse Kidney Events in Extracorporeal Membrane Oxygenation Survivors

Acute Kidney Injury and Kidney Damage in COVID-19 Patients

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