Use of extracorporeal membrane oxygenation in neonates with congenital anomalies of the kidney and urinary tract: a multicenter survey of current practices across CHNC and Pedi-ECMO centers

Abstract

Background: This study aimed to characterize practices and decision-making for extracorporeal membrane oxygenation (ECMO) for congenital anomalies of the kidney and urinary tract (CAKUT). Methods: General practices (GP) section inquired about institutional practices and barriers, ECMO criteria, and dialysis. The hypothetical cases (HC) illustrated four clinical scenarios with varying degrees of renal severity for ECMO candidacy. Results: Then, 99 (42 centers) and 91 (38 centers) physicians completed the GP and HC components, respectively. The majority considered ECMO on a case-by-case basis (66%). Bilateral renal agenesis was the most common diagnosis for exclusion (52%). Prenatal markers used for ECMO exclusion included anhydramnios (43%) and lung volumes (43%). The majority of centers had nephrology involved in ECMO decision-making. Challenges for implementing ECMO included disease heterogeneity (79%) and poor evidence on outcomes (66%). HC responses demonstrated variability in considering ECMO for CAKUT. Conclusions: Variability among providers and institutes underscores the need for consensus-based guidelines to optimize decision-making and outcomes.