Sitbon Alexandre, Coutrot Maxime, Montero Santiago, Chommeloux Juliette, Lebreton Guillaume, Huang Florent, Frapard Thomas, Assouline Benjamin, Pineton De Chambrun Marc, Hekimian Guillaume, Luyt Charles Edouard, Combes Alain, Schmidt Matthieu
Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France.
Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, 08916 Badalona, Spain.
J Crit Care. 2023 Dec;78:154368. doi: 10.1016/j.jcrc.2023.154368. Epub 2023 Aug 2.
The impact of VA-ECMO on early renal recovery (within 7 days after ECMO onset) in patients with pre-ECMO acute kidney injury and cardiogenic shock is unknown.
This retrospective single-center study included adult patients with cardiogenic shock rescued by VA-ECMO and severe AKI occurring before ECMO implantation (pre-ECMO AKI). Patients with early renal recovery (defined as at least a 50% decrease in peak serum creatinine or weaning from renal replacement therapy) were compared to patients without early renal recovery.
During 7 years, 145 patients with severe pre-ECMO AKI were included. Eighty-two patients had no early renal recovery whereas 63 had early renal recovery within 7 days after VA-ECMO onset. The median time to early renal recovery was 4 (3,6) days. Nephrotoxic antibiotics (HR = 0.35 [95% CI, 0.21-0.59], p < 0.001), median fluid balance during the first 7 days of VA-ECMO (HR = 0.77 [95% CI, 0.64-0.93], p = 0.008), pre-ECMO AKI stage 3 (HR = 0.36 [95% CI, 0.20-0.64], p < 0.001) and median vasoactive-inotropic score (HR = 0.99 [95% CI, 0.98,1.00], p = 0.035) were independently associated with no early renal recovery.
Only 43% of patients with severe pre-ECMO AKI had early renal recovery after VA-ECMO initiation.
体外膜肺氧合（VA-ECMO）对体外膜肺氧合开始前发生急性肾损伤和心源性休克患者早期肾脏恢复（体外膜肺氧合开始后7天内）的影响尚不清楚。
这项回顾性单中心研究纳入了接受VA-ECMO救治的心源性休克成年患者以及在体外膜肺氧合植入前发生的严重急性肾损伤（体外膜肺氧合前急性肾损伤）患者。将早期肾脏恢复（定义为血清肌酐峰值至少降低50%或停止肾脏替代治疗）的患者与未早期肾脏恢复的患者进行比较。
在7年期间，纳入了145例严重体外膜肺氧合前急性肾损伤患者。82例患者未早期肾脏恢复，而63例在VA-ECMO开始后7天内实现了早期肾脏恢复。早期肾脏恢复的中位时间为4（3,6）天。肾毒性抗生素（风险比[HR]=0.35[95%置信区间，0.21-0.59]，p<0.001）、VA-ECMO开始后前7天的中位液体平衡（HR=0.77[95%置信区间，0.64-0.93]，p=0.008）、体外膜肺氧合前急性肾损伤3期（HR=0.36[95%置信区间，0.20-0.64]，p<0.001）和中位血管活性药物-正性肌力药物评分（HR=0.99[95%置信区间，0.98,1.00]，p=0.035）与未早期肾脏恢复独立相关。
严重体外膜肺氧合前急性肾损伤患者中，只有43%在启动VA-ECMO后实现了早期肾脏恢复。
