Acute Kidney Injury in ECMO Patients

Ostermann, Marlies; Lumlertgul, Nuttha

doi:10.1007/978-3-030-73231-8_18

Cited by 12 publications

(20 citation statements)

References 51 publications

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“…In CS, renal perfusion decreases due to low cardiac output and causes acute or chronic kidney injury. Patients who developed renal insufficiency and required replacement treatment while on VA-ECMO had higher hospital mortality ( 10 ). In our study, there was an improvement in the mean serum creatinine level and a decreased percentage when compared with the baseline level, but it did not achieve statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…However, studies evaluating outcomes after VA-ECMO initiation have reported a wide difference in the in-hospital mortality, ranging from 10 to 90% according to the etiologies of CS, and the worst outcome was cardiac arrest associated CS (6,7). The use of VA-ECMO is associated with an increased risk of adverse effects such as exacerbated systemic inflammatory response syndrome, catheter-related infection and thrombosis, acute kidney injury, and new organ dysfunction, especially during long-term use (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

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Early Levosimendan Administration Improved Weaning Success Rate in Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock

Chen

Lee

et al. 2022

Front. Cardiovasc. Med.

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BackgroundVenoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used in patients with refractory cardiogenic shock (CS) or out-of-hospital cardiac arrest. It is difficult to perform VA-ECMO weaning, which may cause circulatory failure and death. Levosimendan is an effective inotropic agent used to maintain cardiac output, has a long-lasting effect, and may have the potential benefit for VA-ECMO weaning. The study aimed to explore the relationship between the early use of levosimendan and the rate of VA-ECMO weaning failure in patients on VA-ECMO support for circulatory failure.MethodsAll patients who underwent VA-ECMO in our hospital for CS between January 2017 and December 2020 were recruited in this cohort study and divided into two groups: without and with levosimendan use. Levosimendan was used as an add-on to other inotropic agents as early as possible after VA-ECMO setting. The primary endpoint was VA-ECMO weaning success, which was defined as survival without events for 24 h after VA-ECMO withdrawl. The secondary outcomes were cardiovascular and all-cause mortality at the 30-day and 180-day follow-up periods post-VA-ECMO initialization.ResultsA total of 159 patients were recruited for our study; 113 patients were enrolled in the without levosimendan-use group and 46 patients were enrolled in the levosimendan-use group. In levosimendan-use group, the patients received levosimendan infusion within 24 h after VA-ECMO initialization. Similar hemodynamic parameters were noted between the two groups. Poorer left ventricular ejection fraction and a higher prevalence of intra-aortic balloon pumping were observed in the levosimendan group. An improved weaning rate (without vs. with: 48.7 vs. 82.6%; p < 0.001), lower in-hospital mortality rate (without vs. with: 68.1 vs. 43.5%; p = 0.007), and 180-day cardiovascular mortality (without vs. with: 75.3 vs. 43.2%; p < 0.001) were also noted. Patients administered with levosimendan also presented a lower rate of 30-day (without vs. with: 75.3 vs. 41.3%; p = 0.034) and 180-day (without vs. with: 77.0 vs. 43.2%; p < 0.001) all-cause mortality.ConclusionEarly levosimendan administration may contribute to increasing the success rate of VA-ECMO weaning and may help to decrease CV and all-cause mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early Levosimendan Administration Improved Weaning Success Rate in Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock

Chen

Lee

et al. 2022

Front. Cardiovasc. Med.

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“…The ROC curve also showed an increase in serum creatinine by 68% within 24 h after ECMO support was associated with an increase in in-hospital mortality with an excellent AUC of 0.91. Acute kidney injury has been found to be one of the important prognostic factors in patients who received VA-ECMO for various indications [ 24 ]. Based on the above findings, measures to prevent kidney injury, such as avoiding hypotension and refraining from the use of renal-toxic agents, should be implemented at early phases of disease in patients with FM, even before ECMO support.…”

Section: Discussionmentioning

confidence: 99%

The Early Dynamic Change in Cardiac Enzymes and Renal Function Is Associated with Mortality in Patients with Fulminant Myocarditis on Extracorporeal Membrane Oxygenation: Analysis of a Single Center’s Experience

Lee

et al. 2022

Healthcare

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(1) Background: Fulminant myocarditis (FM) could result in hemodynamic derangement and fatal arrhythmia. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is used to maintain organ perfusion in FM patients complicating cardiogenic shock. The present study aims to assess the static and dynamic factors in association with mortality in FM patients on V-A ECMO (2) Methods: Twenty-eight patients were enrolled between 2013 to 2019 for analysis (3) Results: In-hospital survival rate was 78.5%. There was no statistical difference in demographics and baseline laboratory data between survivors and non-survivors. However, within 24 h after ECMO support, CK-MB increased by 96.8% among non-survivors, but decreased by 23.7% among survivors (p = 0.022). Troponin I increased by 378% among non-survivors and 1.7% among survivors (p = 0.032). Serum creatinine increased by 108% among non-survivors, but decreased by 8.5% among survivors (p = 0.005). The receiver operating characteristic curve suggested an increase in serum creatinine by 68% within 24 h after ECMO support was associated with increased mortality with an area under the curve of 0.91. (4) Conclusions: V-A ECMO is an excellent tool to support FM patients with cardiogenic shock. The early dynamic change of renal function and cardiac enzymes may be useful for outcome assessment.

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“…Though absolute values of PP are of limited use in formalized assessment of ejection (dependent on monitoring site and subject to the effects of resonance and damping), it provides a continuous trend and may alert clinicians to acute cardiovascular changes (either improvement or decline). Pulsatility has also been shown to be key to maintaining renal cortical blood flow and its absence (despite adequate extracorporeal blood flow) may cause and/or significantly worsen acute kidney injury [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Monitoring during extracorporeal membrane oxygenation

Castro

Morris

Teijeiro-Paradis

et al. 2022

Current Opinion in Critical Care

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Purpose of reviewExtracorporeal membrane oxygenation (ECMO) offers advanced mechanical support to patients with severe acute respiratory and/or cardiac failure. Ensuring an adequate therapeutic approach as well as prevention of ECMO-associated complications, by means of timely liberation, forms an essential part of standard ECMO care and is only achievable through continuous monitoring and evaluation. This review focus on the cardiorespiratory monitoring tools that can be used to assess and titrate adequacy of ECMO therapy; as well as methods to assess readiness to wean and/or discontinue ECMO support. Recent findingsSurrogates of tissue perfusion and near infrared spectroscopy are not standards of care but may provide useful information in select patients. Echocardiography allows to determine cannulas position, evaluate cardiac structures, and function, and diagnose complications. Respiratory monitoring is mandatory to achieve lung protective ventilation and identify early lung recovery, surrogate measurements of respiratory effort and ECMO derived parameters are invaluable in optimally managing ECMO patients. SummaryNovel applications of existing monitoring modalities alongside evolving technological advances enable the advanced monitoring required for safe delivery of ECMO. Liberation trials are necessary to minimize time sensitive ECMO related complications; however, these have yet to be standardized.

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Acute Kidney Injury in ECMO Patients

Cited by 12 publications

References 51 publications

Early Levosimendan Administration Improved Weaning Success Rate in Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock

Early Levosimendan Administration Improved Weaning Success Rate in Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock

The Early Dynamic Change in Cardiac Enzymes and Renal Function Is Associated with Mortality in Patients with Fulminant Myocarditis on Extracorporeal Membrane Oxygenation: Analysis of a Single Center’s Experience

Monitoring during extracorporeal membrane oxygenation

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