Prognostic effect of estimated glomerular filtration rate in patients with cardiogenic shock or cardiac arrest undergoing percutaneous veno-arterial extracorporeal membrane oxygenation

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Abstract

Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can improve survival in patients with cardiogenic shock or cardiac arrest. We investigated the association between initial renal function and clinical outcome in patients undergoing VA-ECMO for cardiogenic shock and cardiac arrest. Methods This was a single-center, retrospective cohort study of 287 patients who underwent ECMO at our hospital from January 2005 to December 2014. We excluded 70 patients with non-cardiogenic events. The remaining 217 patients were divided into 2 groups according to initial estimated glomerular filtration rate (eGFR): Initial high eGFR (non-renal failure: non-RF) group: eGFR ≥ 60 ml/min/1.73 m2 (n = 73) and initial low eGFR (RF) group: eGFR < 60 ml/min/1.73 m2 (n = 144). Clinical outcome was defined as all-cause death at 30 days after extracorporeal life support. Results VA-ECMO was begun in 87% of patients for cardiac arrest. The non-RF group was significantly younger (51.6 vs. 62.6 years), had lower body mass index (22.8 vs. 24.7 kg/m2), lower blood urea nitrogen (14.4 vs. 23.9 mg/dl), and lower K (4.0 vs. 4.5 mEq/l, all p < 0.05) than the RF group. Incidence of all-cause death at 30 days was significantly lower in the non-RF than RF group (49% vs. 76%, p < 0.0001). Initial low eGFR was an independent predictor of mortality after adjustment for multiple cofounders (OR: 4.08, 95% CI: 1.77–9.42, p < 0.001). Kaplan–Meier curve showed better outcome in the non-RF versus RF group (p = 0.0009). Conclusion An initial low eGFR may predict worse clinical outcome in patients undergoing VA-ECMO for cardiogenic shock and cardiac arrest.

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Kuroki, N., Abe, D., Iwama, T., Sugiyama, K., Akashi, A., Hamabe, Y., … Sato, A. (2016). Prognostic effect of estimated glomerular filtration rate in patients with cardiogenic shock or cardiac arrest undergoing percutaneous veno-arterial extracorporeal membrane oxygenation. Journal of Cardiology, 68(5), 439–446. https://doi.org/10.1016/j.jjcc.2015.10.014

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