Long-term renal function after venoarterial extracorporeal membrane oxygenation

Area of Science:

• Cardiology
• Nephrology
• Critical Care Medicine

Background:

• Venoarterial extracorporeal membrane oxygenation (VA-ECMO) use has surged, raising questions about long-term outcomes.
• Long-term organ function, particularly the need for dialysis, is a key concern for VA-ECMO survivors.

Purpose of the Study:

• To determine the incidence of long-term dialysis (LT-dialysis) requirement after discharge in adult VA-ECMO survivors.
• To identify factors associated with the need for LT-dialysis post-VA-ECMO.

Main Methods:

• Retrospective review of 283 adult VA-ECMO patients from January 2014 to October 2018.
• Utilized over 208 patient-years of follow-up data to assess LT-dialysis incidence.
• Analyzed patient characteristics and in-hospital treatments, including renal replacement therapy during VA-ECMO.

Main Results:

• Of 99 survivors, 88 (89%) did not require LT-dialysis.
• Patients treated for decompensated cardiogenic shock were more likely to need LT-dialysis (p=0.034).
• 27 patients requiring renal replacement therapy during VA-ECMO had a 33% incidence of LT-dialysis.

Conclusions:

• Long-term dialysis dependence is uncommon among VA-ECMO survivors.
• VA-ECMO should be considered a life-saving therapy without undue concern for long-term renal sequelae.
• Further research may elucidate specific risk factors for renal dysfunction post-VA-ECMO.