Timing of Kidney Replacement Therapy Initiation and Survival during Pediatric Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Study

Pilar Anton-Martin; Vinai Modem; Brian Bridges; Alvaro Coronado Munoz; Matthew Paden; Meredith Ray; Hitesh S Sandhu

doi:10.1097/MAT.0000000000002151

Timing of Kidney Replacement Therapy Initiation and Survival during Pediatric Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Study

ASAIO J. 2024 Jan 31. doi: 10.1097/MAT.0000000000002151. Online ahead of print.

Authors

Pilar Anton-Martin¹, Vinai Modem², Brian Bridges³, Alvaro Coronado Munoz⁴, Matthew Paden⁵, Meredith Ray⁶, Hitesh S Sandhu⁷

Affiliations

¹ Department of Pediatrics, Division of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
² Department of Pediatrics, Pediatric Intensive Care Unit, Cooks Children's Medical Center, Fort Worth, Texas.
³ Department of Pediatrics, Division of Critical Care, Vanderbilt University School of Medicine/Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
⁴ Department of Pediatrics, Division of Critical Care, The Children's Hospital at Montefiore, Bronx, New York.
⁵ Department of Pediatrics, Division of Critical Care, Emory University School of Medicine/Children's Healthcare of Atlanta, Atlanta, Georgia.
⁶ Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee; and.
⁷ Department of Pediatrics, Division of Critical Care, University of Tennessee Health Science Center, Memphis, Tennessee.

PMID: 38295389
DOI: 10.1097/MAT.0000000000002151

Abstract

To characterize kidney replacement therapy (KRT) and pediatric extracorporeal membrane oxygenation (ECMO) outcomes and to identify the optimal timing of KRT initiation during ECMO associated with increased survival. Observational retrospective cohort study using the Extracorporeal Life Support Organization Registry database in children (0-18 yo) on ECMO from January 1, 2016, to December 31, 2020. Of the 14,318 ECMO runs analyzed, 26% of patients received KRT during ECMO. Patients requiring KRT before ECMO had increased mortality to ECMO decannulation (29% vs. 17%, OR 1.97, P < 0.001) and to hospital discharge (58% vs. 39%, OR 2.16, P < 0.001). Patients requiring KRT during ECMO had an increased mortality to ECMO decannulation (25% vs. 15%, OR 1.85, P < 0.001) and to hospital discharge (56% vs. 34%, OR 2.47, P < 0.001). Multivariable logistic regression demonstrated that the need for KRT during ECMO was an independent predictor for mortality to ECMO decannulation (OR 1.49, P < 0.001) and to hospital discharge (OR 2.02, P < 0.001). Patients initiated on KRT between 24 and 72 hours after cannulation were more likely to survive to ECMO decannulation and showed a trend towards survival to hospital discharge as compared to those initiated before 24 hours and after 72 hours.