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Acute Kidney Injury After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest

Takuya Taira^1,2, Akihiko Inoue¹, Shinichi Ijuin¹

¹Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Hyogo, Japan.

Critical Care Medicine

|November 12, 2025

Abstract

Objectives:

Acute kidney injury (AKI) occurs frequently in ICUs and is associated with poor outcomes. However, little is known about AKI in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA). Our aims were to identify real-world data on AKI in the early phase of intensive care, examine the relationship between AKI and outcomes, and identify factors contributing to the occurrence of AKI in patients undergoing ECPR for OHCA.

Design:

A secondary analysis of the Study of Advanced life support for Ventricular fibrillation with Extracorporeal circulation in Japan (SAVE-J II study), a retrospective multicenter study involving patients 18 years old or older who experienced OHCA and received ECPR between 2013 and 2018.

Setting:

Thirty-six ICUs that participated in the SAVE-J II study in Japan.

Patients:

Adult patients with OHCA of presumed cardiac etiology who received ECPR and were admitted to the ICU.

Interventions:

None.

Measurements And Main Results:

In this study, AKI was defined based on the Kidney Disease: Improving Global Outcomes criteria with regard to serum creatinine level during the 4 days after ICU admission. The primary outcome was in-hospital mortality, and the secondary outcome was an unfavorable neurologic outcome (Cerebral Performance Category scores of 3-5 at discharge). Among the 943 patients, AKI occurred in 66.9% ( n = 631). Multivariable analysis showed that AKI was significantly associated with in-hospital mortality (odds ratio [OR], 4.15; 95% CI, 3.05-5.66; p < 0.001) and with unfavorable neurologic outcomes (OR, 3.43; 95% CI, 2.42-4.87; p < 0.001). Furthermore, age, time course, pH level at hospital arrival, creatinine level at hospital admission, and blood pressure on ICU admission were significantly associated with the occurrence of AKI.

Conclusions:

This large cohort study revealed that AKI was commonly observed during the early phase after ECPR for OHCA and was associated with in-hospital mortality and unfavorable neurologic outcomes.

Keywords:

acute kidney injury extracorporeal cardiopulmonary resuscitation mortality neurologic outcome out-of-hospital cardiac arrest

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