scholarly journals Extracorporeal Membrane Oxygenation and the Kidney

2015 ◽  
Vol 6 (1) ◽  
pp. 50-60 ◽  
Author(s):  
Gianluca Villa ◽  
Nevin Katz ◽  
Claudio Ronco
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Oxygen Delivery ◽  
Fluid Management ◽  
Kidney Injury ◽  
Fold Increase ◽  
Membrane Oxygenation ◽  
Inflammatory Damage ◽  
Extracorporeal Therapy ◽  
Renal Oxygen

Background: Extracorporeal membrane oxygenation (ECMO) is an effective therapy for patients with reversible cardiac and/or respiratory failure. Acute kidney injury (AKI) often occurs in patients supported with ECMO; it frequently evolves into chronic kidney damage or end-stage renal disease and is associated with a reported 4-fold increase in mortality rate. Although AKI is generally due to the hemodynamic alterations associated with the baseline disease, ECMO itself may contribute to maintaining kidney dysfunction through several mechanisms. Summary: AKI may be related to conditions derived from or associated with extracorporeal therapy, leading to a reduction in renal oxygen delivery and/or to inflammatory damage. In particular, during pathological conditions requiring ECMO, the biological defense mechanisms maintaining central perfusion by a reduction of perfusion to peripheral organs (such as the kidney) have been identified as pretreatment and patient-related risk factors for AKI. Hormonal pathways are also impaired in patients supported with ECMO, leading to failures in mechanisms of renal homeostasis and worsening fluid overload. Finally, inflammatory damage, due to the primary disease, heart and lung crosstalk with the kidney or associated with extracorporeal therapy itself, may further increase the susceptibility to AKI. Renal replacement therapy can be integrated into the main extracorporeal circuit during ECMO to provide for optimal fluid management and removal of inflammatory mediators. Key Messages: AKI is frequently observed in patients supported with ECMO. The pathophysiology of the associated AKI is chiefly related to a reduction in renal oxygen delivery and/or to inflammatory damage. Risk factors for AKI are associated with a patient's underlying disease and ECMO-related conditions.

‘Goal-directed extracorporeal circulation: transferring the knowledge and experience from daily cardiac surgery to extracorporeal membrane oxygenation’

Perfusion ◽  
2021 ◽  
pp. 026765912110638
Author(s):  
Ignazio Condello ◽  
Giuseppe Santarpino ◽  
Giuseppe Nasso ◽  
Marco Moscarelli ◽  
Giuseppe Speziale ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Oxygen Delivery ◽  
Life Support ◽  
Scientific Evidence ◽  
Kidney Injury ◽  
Form Of Life ◽  
Membrane Oxygenation ◽  
Metabolic Management ◽  
Vasopressor Use

Metabolism management plays an essential role in extracorporeal technologies. There are different metabolic management devices integrated to extracorporeal devices; the most commonly used and accepted metabolic target in adult patients is indexed oxygen delivery (280 mL/min/m2) and cardiac index (2.4 L/min/m2), which can be managed independently or according to other metabolic parameters. Extracorporeal membrane oxygenation (ECMO) is a temporary form of life support providing a prolonged biventricular circulatory and pulmonary support for patients experiencing both pulmonary and cardiac failure unresponsive to conventional therapy. The goal-directed perfusion initiative during cardiopulmonary bypass (CPB) reduced the incidence of acute kidney injury after cardiac surgery. On the basis of the available literature, the identified goals to achieve during CPB include maintenance of oxygen delivery > 300 mL O2/min/m2 and reduction in vasopressor use. ECMO and CPB are conceptually similar but differ in many aspects and finality; in particular, they differ in the scientific evidence for metabolic management nadirs. As for CPB, predictive target parameters have been found and consolidated, particularly in terms of acute renal injury and the prevention of anaerobic metabolism, while for ECMO management, a blurred path remains. In this context, we review the strategies for optimal goal-directed therapy during CPB and ECMO, trying to transfer the knowledge and experience from daily cardiac surgery to veno-arterial ECMO.

scholarly journals Risk Factors for Acute Kidney Injury and In-Hospital Mortality in Patients Receiving Extracorporeal Membrane Oxygenation

PLoS ONE ◽  
2015 ◽  
Vol 10 (10) ◽  
pp. e0140674 ◽  
Author(s):  
Sung Woo Lee ◽  
Mi-yeon Yu ◽  
Hajeong Lee ◽  
Shin Young Ahn ◽  
Sejoong Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Membrane Oxygenation

scholarly journals Risk Factors Analysis of Acute Kidney Injury in Adult Patients Receiving Extracorporeal Membrane Oxygenation

2020 ◽  
Author(s):  
Zhixiang Mou
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Liver Cirrhosis ◽  
Extracorporeal Membrane Oxygenation ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Ecmo Support ◽  
Adult Patients ◽  
Severe Bleeding ◽  
Membrane Oxygenation

AbstractBackgroundAcute kidney injury (AKI) has been reported as one of the most common complication in patients receiving extracorporeal membrane oxygenation (ECMO), the risk factors of AKI on ECMO is unknown. This meta-analysis aimed to find out the risk factors of AKI among adult patients receiving ECMO.MethodsA literature search was performed using PubMed,Web of Science, and Embase fulfilled the pre-specified criteria until April 2020 to include studies reported the necessary clinic characteristics, then the gender, cancer, diffuse intravascular coagulation (DIC), massive/severe Bleeding, intra-aortic balloon pump (IABP), post-cardiotomy, diabetes mellitus, liver cirrhosis and ECMO support duration were pooled for further analysis by STATA to get conclusion.ResultsThis research is first time to provide the evidence that patients developed AKI/severe AKI with a longer ECMO support duration (pooled WMD, 4.09 days; 95% CI: 2.45-5.73 days, Z= 4.89, P= 0.000, I2= 73.4%, χ2P= 0.023/pooled WMD, 1.52 days; 95% CI: 0.19-2.85 days, Z= 2.25, P= 0.025, I2= 77.4%, χ2P= 0.001) and the risk of severe AKI requiring RRT was higher (pooled OR, 2.22; 95% CI: 1.24-3.99, Z= 2.68, P= 0.007, I2= 0.0%, χ2P= 0.634) in liver cirrhosis patients by systemic analysis, indicated ECMO support duration and liver cirrhosis may act as risk factors of AKI in adult patients received ECMO.

scholarly journals Clinical Characteristics and Outcomes of Children With Extracorporeal Membrane Oxygenation in a Developing Country: An 11-Year Single-Center Experience

2021 ◽  
Vol 9 ◽  
Author(s):  
Wirapatra Iamwat ◽  
Piya Samankatiwat ◽  
Rojjanee Lertbunrian ◽  
Nattachai Anantasit
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Developing Country ◽  
Enteral Feeding ◽  
Kidney Injury ◽  
Membrane Oxygenation ◽  
Single Center Experience ◽  
Potential Risk Factors ◽  
Poor Outcomes

Introduction: Extracorporeal Membrane Oxygenation (ECMO) is a lifesaving procedure for patients with refractory cardiac or respiratory failure. The indications for ECMO are growing, and it is increasingly being used to support cardiopulmonary failure in children. However, the risks and benefits of ECMO should be weighed before deploying it on the patients. The objectives of this study were to identify the mortality risk factors and to determine the ECMO outcomes.Methods: The retrospective chart reviews were done for all patients aged 1 day−20 years old receiving ECMO between January 2010 and December 2020.Results: Seventy patients were enrolled in the study. The median age was 31.3 months. The incidence of VA and VV ECMO was 85.7 and 14.3%, respectively. The most common indication for ECMO was the failure to wean off cardiopulmonary bypass after cardiac surgery. Pre-existing acute kidney injury (OR 4.23; 95% CI 1.34–13.32, p = 0.014) and delayed enteral feeding (OR 3.85, 95% CI 1.23–12.02, p = 0.020), and coagulopathy (OD 12.64; 95% CI 1.13–141.13, p = 0.039) were associated with the higher rate of mortality. The rates of ECMO survival and survival to discharge were 70 and 50%, respectively.Conclusion: ECMO is the lifesaving tool for critically ill pediatric patients. Pre-existing acute kidney injury, delayed enteral feeding, and coagulopathy were the potential risk factors associated with poor outcomes in children receiving ECMO. However, ECMO setup can be done successfully in a developing country.

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