Abstract
Background: Veno-arterial extracorporeal life support (V-A ECLS) has become a cornerstone in the management of critical cardiogenic shock, but it can also precipitate organ injury, e.g., acute kidney injury (AKI). Available studies highlight the effect of non-cardiac organ injury on patient outcomes. Only very little is known about the impact of non-cardiac organ recovery on patient survival. AKI occurs frequently during cardiogenic shock and carries a poor prognosis. We have developed descriptive models to hypothesize on the role of AKI severity versus that of recovery of renal function for patient survival. Methods: Retrospective, observational study including 175 patients who were successfully decannulated from V-A ECLS. We assessed AKI severity using the “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria. We defined recovered or preserved renal function (RPRF) prior to decannulation from V-A ECLS as 0 (AKI with no improvement) or 1 (no AKI or AKI with improvement). We classified patient outcomes as alive or dead at hospital discharge. Results: 78% (n = 138) of all patients survived hospital discharge of which 38% (n = 67) never developed AKI. After adjusting for shock severity and non-renal organ injury, RPRF emerged as an independent predictor of survival in both the overall cohort [OR (95% CI) – 4.11 (1.72–9.79)] and the AKI-only sub-cohort [OR (95% CI) – 5.18 (1.8–14.92)]. Neither maximum KDIGO stage nor KDIGO stage at the end of V-A ECLS was independently associated with survival. Conclusions: Our model identifies RPRF, but not AKI severity, as an independent predictor of hospital survival in patients undergoing V-A ECLS for cardiogenic shock. We hypothesize that recovered or preserved non-cardiac organ function during V-A ECLS is crucial for patient survival.
Original language | English (US) |
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Pages (from-to) | 554-565 |
Number of pages | 12 |
Journal | Artificial organs |
Volume | 47 |
Issue number | 3 |
DOIs | |
State | Published - Mar 2023 |
All Science Journal Classification (ASJC) codes
- Bioengineering
- Medicine (miscellaneous)
- Biomaterials
- Biomedical Engineering