Original article
Adult cardiac
Prognosis of Patients on Extracorporeal Membrane Oxygenation: The Impact of Acute Kidney Injury on Mortality

https://doi.org/10.1016/j.athoracsur.2010.08.063Get rights and content

Background

Extracorporeal membrane oxygenation (ECMO) has been utilized for patients in critical condition, such as those with life-threatening respiratory failure or postcardiotomy cardiogenic shock. This study analyzed the outcomes of patients treated with ECMO and identified the relationship between prognosis and the Acute Kidney Injury Network (AKIN) scores obtained at pre-ECMO support (AKIN0-hour); and at post-ECMO support 24 hours (AKIN24-hour) and 48 hours (AKIN48-hour).

Methods

This study reviewed the medical records of 102 critically ill patients on ECMO support at a specialized intensive care unit at a tertiary care university hospital between March 2002 and January 2008. Demographic, clinical, and laboratory variables were retrospectively collected as survival predicators.

Results

The overall mortality rate was 57.8%. The most common condition requiring ECMO support was cardiogenic shock. Goodness-of-fit was good for AKIN0-hour, AKIN24-hour, and AKIN48-hour criteria. The AKIN0-hour, AKIN24-hour, and AKIN48-hour scoring systems also had excellent areas under the receiver operating characteristic curve (0.804 ± 0.046, 0.811 ± 0.045, and 0.858 ± 0.040, respectively). Furthermore, multiple logistic regression analysis indicated that AKIN48-hour, age, and Glasgow Coma Scale score on the first day of intensive care unit admission were independent risk factors for hospital mortality. Finally, cumulative survival rates at 6-month follow-up after hospital discharge differed significantly (p < 0.05) for AKIN48-hour stage 0 versus AKIN48-hour stages 1, 2, and 3; and AKIN48-hour stage 1 and 2 versus AKIN48-hour stage 3.

Conclusions

During ECMO support, the AKIN48-hour scoring system proved to be a reproducible evaluation tool with excellent prognostic abilities for these patients.

Section snippets

Patient Information and Data Collection

The local Institutional Review Board approved the study protocol (96-0004B). The medical records of 102 of 120 patients on ECMO support in a 20-bed specialized cardiovascular surgery intensive care unit between March 2002 and January 2008 were examined. Patients on ECMO support who did within 48 hours (18 patients) were excluded.

Retrospective data obtained are as follows: demographics; primary diagnosis for ECMO implementation; AKIN scores at pre-ECMO support (AKIN0-hour); at post-ECMO 24 hours

Subject Characteristics

The study population comprised 102 patients on ECMO support at the cardiovascular surgery intensive care unit between March 2002 and January 2008. Patient median age was 52 years; 62 (61%) were male and 40 (39%) were female. In-hospital mortality for the entire group was 57.8% (59 of 102). Table 2 lists patient demographic data and clinical characteristics for both survivors and nonsurvivors. An extremely high mortality rate, 85% (22 of 26) was noted for patients treated with ECMO and CRRT, 83%

Comment

Several previous studies have identified a mortality rate of 48% to 76% for patients on ECMO support [1, 2, 11, 12]. The hospital mortality rate for patients in this study was 57.8%. Analytical results confirm this grave prognosis for this patient subgroup on ECMO support. The AKIN group attempted to improve the sensitivity and reproducibility of AKI criteria and defined the AKIN classification. We propose that AKIN48-hour score can increase the accuracy of short-term prognosis in this patient

References (19)

There are more references available in the full text version of this article.

Cited by (86)

  • Risk factors for in-hospital mortality and acute kidney injury in neonatal-pediatric patients receiving extracorporeal membrane oxygenation

    2021, Journal of the Formosan Medical Association
    Citation Excerpt :

    Patients receiving ECMO support are at risk for neurological injury due to pre-ECMO medical conditions, management during ECMO support, or combined effects.18 Chen et al. indicated GCS score on the first day were independent risk factor for hospital mortality in adult patients with ECMO.8 A low GCS score indicates severe brain injury, probably resulting from severe cardiopulmonary decompensation.

View all citing articles on Scopus
View full text