scholarly journals In-Hospital Outcomes Following Extracorporeal Membrane Oxygenation in a Retrospective Cohort of Infants

2017 ◽  
Vol 34 (13) ◽  
pp. 1347-1353
Author(s):  
Maya Schueller ◽  
Rachel Greenberg ◽  
P. Smith ◽  
Matthew Laughon ◽  
Reese Clark ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Term Infants ◽  
Health Records ◽  
Future Studies ◽  
Membrane Oxygenation

Objective We sought to characterize associations between infant characteristics and extracorporeal membrane oxygenation (ECMO) survival using electronic health records data. Study Design We examined a cohort study of infants ≥32 weeks of gestational age and ≥1,800 g birth weight supported with ECMO in a Pediatrix Medical Group neonatal intensive care unit from 1998 to 2013. Results We identified 268 infants, of which 45 (17%) were <37 weeks of gestational age. Survival to discharge was 87% but was lower in premature compared with term infants (76 vs. 89%, p = 0.03). In multivariable analysis, acute kidney injury (odds ratio [OR] = 4.00; 95% confidence interval [CI] = 1.05, 15.24), postnatal age at cannulation of 7 to 13 days (OR = 5.86; 95% CI = 1.21, 28.44), and venoarterial ECMO cannulation (OR = 4.33; 95% CI = 1.77, 10.60) were associated with lower survival. Conclusion ECMO cannulation type, postnatal age, and acute kidney injury were associated with lower ECMO survival, while prematurity was not. Future studies are needed to identify risk factors and strategies to improve outcomes.

Does acute kidney injury affect survival in adults with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation?

Perfusion ◽  
2018 ◽  
Vol 33 (5) ◽  
pp. 375-382 ◽  
Author(s):  
Richard Devasagayaraj ◽  
Nicholas C. Cavarocchi ◽  
Hitoshi Hirose
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Kidney Injury ◽  
Membrane Oxygenation ◽  
Vv Ecmo

Introduction: Patients who develop severe acute respiratory distress syndrome (ARDS) despite full medical management may require veno-venous extracorporeal membrane oxygenation (VV ECMO) to support respiratory function. Survival outcomes remain unclear in those who develop acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) during VV ECMO for isolated severe respiratory failure in adult populations. Methods: A retrospective chart review (2010-2016) of patients who underwent VV ECMO for ARDS was conducted with university institutional review board (IRB) approval. Patients supported by veno-arterial ECMO were excluded. AKI was defined by acute renal failure receiving CRRT and the outcomes of patients on VV ECMO were compared between the AKI and non-AKI groups. Results: We identified 54 ARDS patients supported by VV ECMO (mean ECMO days 12 ± 6.7) with 16 (30%) in the AKI group and 38 (70%) in the non-AKI group. No patient had previous renal failure and the serum creatinine was not significantly different between the two groups at the time of ECMO initiation. The AKI group showed a greater incidence of complications during ECMO, including liver failure (38% vs. 5%, p=0.002) and hemorrhage (94% vs. 45%, p=0.0008). ECMO survival of the AKI group (56% [9/16]) was inferior to the non-AKI group (87% [33/38], p=0.014). Conclusions: Our study demonstrated that VV ECMO successfully manages patients with severe isolated lung injury. However, once patients develop AKI during VV ECMO, they are likely to further develop multi-organ dysfunction, including hepatic and hematological complications, leading to inferior survival.

scholarly journals Acute Kidney Injury, Fluid Overload, and Outcomes in Children Supported With Extracorporeal Membrane Oxygenation for a Respiratory Indication

ASAIO Journal ◽  
2020 ◽  
Vol 66 (3) ◽  
pp. 319-326 ◽  
Author(s):  
Palen P. Mallory ◽  
David T. Selewski ◽  
David J. Askenazi ◽  
David S. Cooper ◽  
Geoffrey M. Fleming ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Membrane Oxygenation

scholarly journals Impact of an inline extracorporeal membrane oxygenation hemofilter system in neonatal acute kidney injury

2018 ◽  
Vol Volume 14 ◽  
pp. 811-816
Author(s):  
Mohammed Azar ◽  
Abdulrahman Alamir ◽  
Abdullah Thabet Al Qahtani ◽  
Khamisa Al Mokali ◽  
Khalid Al Fakeeh
Keyword(s):  
Acute Kidney Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Kidney Injury ◽  
Membrane Oxygenation

scholarly journals No Difference in Risk of Acute Kidney Injury Between Adult Patients Receiving Different Types of Extracorporeal Membrane Oxygenation

2020 ◽  
Author(s):  
Zhixiang Mou ◽  
Xu Zhang
Keyword(s):  
Acute Kidney Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Web Of Science ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
Significant Difference ◽  
Different Types ◽  
Va Ecmo

AbstractAcute kidney injury (AKI) has been reported as one of the most common complications in patients receiving extracorporeal membrane oxygenation (ECMO), yet the risk of AKI on different types of ECMO remains unclear. This meta-analysis aimed to compare risk of AKI among adult patients requiring different types of ECMO. Two authors independently performed a literature search using PubMed, Web of Science, and Embase, encompassing publications up until Arpril 20, 2020 (inclusive). The number of AKI patients, non-AKI patients, patients required RRT and patients not required RRT receiving different types of ECMO were derived and analyzed by STATA. The results indicated there was no significant difference in risk of AKI (OR, 1.54; 95% CI: 0.75-3.16; P= 0.235) and severe AKI required RRT (OR, 1.0; 95% CI: 0.66-1.5, P= 0.994) in patients receiving different types of ECMO. In Conclusion, no difference in risk of AKI and severe AKI required RRT between patients receiving VA ECMO and VV ECMO. More studies are required to support the findings.

scholarly journals Serum chloride and sodium concentration as a predictor of acute kidney injury in premature newborns

2017 ◽  
Vol 145 (7-8) ◽  
pp. 340-345
Author(s):  
Drazenka Todorovic ◽  
Vesna Stojanovic ◽  
Aleksandra Doronjski
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
Sodium Concentration ◽  
Premature Newborns ◽  
Serum Chloride

Introduction/Objective. Hyperchloremia is often registered in adults? studies after administration with 0.9% sodium chloride, which contributes to the development of acute kidney injury (AKI) as it leads to vasoconstriction of renal blood vessels. The aim of this study was to determine the correlation of sodium and chloride imbalance with the development of AKI, with consideration of other risk factors for this disorder. Methods. This retrospective study included 146 randomly selected preterm infants hospitalized at the Neonatal Intensive Care Unit from 2008 to 2015. Results. Among the patients registered for the study, 23.97% developed AKI, and they were of a significantly lower gestational age (26.3 ? 2.8 weeks vs. 31.7 ? 2.90 weeks, p < 0.05); birth weight (971.31 ? 412.1 g vs. 1,753.3 ? 750.3 g, p < 0.05); Apgar score in the first (3.2 ? 1.7 vs. 5.7 ? 2.4, p < 0.05) and fifth minute (5.3 ? 1.7 vs. 7.1 ? 1.8, p < 0.05) of life compared to those without AKI. The neonates with AKI had significantly higher maximum chloremia (Clmax: 114.1 ? 8.4 vs. 111.7 ? 4.6, p = 0.029) and maximum natremia (Namax: 147.9 ? 8.8 vs. 142.9 ? 4, p < 0.05). Each of these parameters is (independently) a statistically significant risk factor for the development of AKI, and gestational age is the strongest (OR = 1 / 0.643 = 1.55; 95% CI 1.24?1.94). Mortality in neonates with AKI was higher than in neonates without AKI (19.4% vs. 92.7%, p < 0.05). Conclusion. Hyperchloremia and hypernatremia are more common in the premature newborns with AKI compared to the premature newborns without AKI. Higher maximum sodium and chloride values are independent risk factors for AKI.

Renal function in children assisted with extracorporeal membrane oxygenation

2019 ◽  
Vol 43 (2) ◽  
pp. 119-126 ◽  
Author(s):  
Jesús López-Herce ◽  
Elisa Casado ◽  
Marta Díez ◽  
Amelia Sánchez ◽  
Sarah Nicole Fernández ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Pediatric Intensive Care Unit ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Stage I ◽  
Membrane Oxygenation

Acute kidney injury is a frequent complication in patients requiring extracorporeal membrane oxygenation. A single-center retrospective analysis from a prospective observational database assessing the incidence of acute kidney injury in children undergoing extracorporeal membrane oxygenation, the use of continuous renal replacement therapy and its association with outcomes was performed. One hundred children were studied. Creatinine was normal in 33.3% of children at the beginning of extracorporeal membrane oxygenation, between 1.5 and 2 times its baseline levels in 18.4% of children (stage I acute kidney injury), between 2 and 3 times baseline levels (stage II) in 20.7%, and over 3 times baseline levels or requiring continuous renal replacement therapy (stage III) in 27.6% of the patients. Eighteen patients were on continuous renal replacement therapy before the beginning of extracorporeal membrane oxygenation, 81 required continuous renal replacement therapy during extracorporeal membrane oxygenation, and 38 after weaning from extracorporeal membrane oxygenation, but none of them did at discharge from the pediatric intensive care unit. Fifty-one children survived to pediatric intensive care unit discharge. Mortality was lower in children with normal kidney function or with stage I acute kidney injury at the beginning of extracorporeal membrane oxygenation than in those with stage II or III acute kidney injury (33.3% vs 58.3%, p = 0.021). Mortality in children requiring continuous renal replacement therapy during extracorporeal membrane oxygenation was 54.3% and 21.1% in the rest of patients (p < 0.01). We conclude that kidney function is significantly impaired in a high percentage of children undergoing extracorporeal membrane oxygenation and many of them are treated with continuous renal replacement therapy. Patients treated with continuous renal replacement therapy have a higher mortality than those with normal kidney function or stage I acute kidney injury at the beginning of extracorporeal membrane oxygenation. Most patients surviving to pediatric intensive care unit discharge recover normal renal function after weaning from extracorporeal membrane oxygenation.

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