Acute Kidney Injury and Fluid Overload in Pediatric Extracorporeal Cardio-Pulmonary Resuscitation: A Multicenter Retrospective Cohort Study. ASAIO J 2022 Jul 01;68(7):956-963
Date
10/14/2021Pubmed ID
34643574DOI
10.1097/MAT.0000000000001601Scopus ID
2-s2.0-85133144425 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
Acute kidney injury (AKI) and fluid overload (FO) are common complications of extracorporeal membrane oxygenation (ECMO). The purpose of this study was to characterize AKI and FO in children receiving extracorporeal cardiopulmonary resuscitation (eCPR). We performed a multicenter retrospective study of children who received eCPR. AKI was assessed during ECMO and FO defined as <10% [FO-] vs. ≥10% [FO+] evaluated at ECMO initiation and discontinuation. A composite exposure, defined by a four-group discrete phenotypic classification [FO-/AKI-, FO-/AKI+, FO+/AKI-, FO+/AKI+] was also evaluated. Primary outcome was mortality and hospital length of stay (LOS) among survivors. 131 patients (median age 29 days (IQR:9, 242 days); 51% men and 82% with underlying cardiac disease) were included. 45.8% survived hospital discharge. FO+ at ECMO discontinuation, but not AKI was associated with mortality [aOR=2.3; 95% CI: 1.07-4.91]. LOS for FO+ patients was twice as long as FO- patients, irrespective of AKI status [(FO+/AKI+ (60 days; IQR: 49-83) vs. FO-/AKI+ (30 days, IQR: 19-48 days); P = 0.01]. FO+ at ECMO initiation and discontinuation was associated with an adjusted 66% and 50% longer length of stay respectively. Prospective studies that target timing and strategy of fluid management, including its removal in children receiving ECPR are greatly needed.
Author List
Gist KM, Misfeldt A, Sahay RD, Gorga SM, Askenazi DJ, Bridges BC, Paden ML, Zappitelli M, Gien J, Basu RK, Jetton JG, Murphy HJ, King E, Fleming GM, Selewski DT, Cooper DSAuthor
Jennifer G. Jetton MD Chief, Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Acute Kidney InjuryAdult
Cardiopulmonary Resuscitation
Child
Extracorporeal Membrane Oxygenation
Female
Heart Failure
Humans
Male
Prospective Studies
Retrospective Studies
Treatment Outcome
Water-Electrolyte Imbalance