1093: ACUTE KIDNEY INJURY AFTER TRIPLE CANNULATION IN EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT

Abstract

Introduction: Extracorporeal Membrane Oxygenation (ECMO) is a temporary means to provide cardiorespiratory hemodynamic support in critically ill patients. Both patient and circuit-related factors are responsible for changes in modifications of conventional VA and VV ECMO circuits for optimal support. Despite the benefits, ECMO is associated with a multitude of adverse effects including acute kidney injury. AKI aggravates the morbidity and mortality in these populations. Triple cannulation further adds to the complexity of the circuit which can aggravate renal injury. This Systematic review and meta-analysis aimed to determine the mortality and development of AKI after triple ECMO cannulation. Methods: A comprehensive literature search was conducted across the Ovid MEDLINE® database using the terms “Extracorporeal Membrane Oxygenation” or “ECMO” or “veno-arteriovenous” or “Triple Cannulation ECMO” or “veno-veno-arterial” or “veno-arterio-venous” or “veno-pulmonary-arterial” or “veno-arteriovenous ECMO” etc. The inclusion criteria were: age ≥18 years, retrospective analysis of patients who required Triple Cannulation ECMO at some point during their hospital course; the study was conducted in or after 2000; they described patients who developed acute Kidney Injury/required renal replacement therapy after initiation of ECMO. Review Manager 5.4 was used to evaluate the odds ratio (OR) with respective 95% confidence intervals (CI) using a random-effects model. Results: In total 60 studies were included for abstract review. The full-text review was done for 17 articles. 11 articles were selected for meta-analysis. The total number of patients was 328. The average age of the study population was 49.8 years (+/- 7.17). The odds of in-hospital mortality were 1.15 (0.86, 1.53). The Odds ratio for developing Acute kidney injury after versus before triple cannulation ECMO came out to be 21.8 (7.4, 64.18). Conclusions: Triple cannulation strategies in ECMO-supported patients are associated with increased odds of developing acute kidney injury. Moreover, the kidney injury was severe in most of the cases necessitating renal replacement therapy. Factors accounting for this observation could be explained by the clinical severity of the patient population and the increased complexity of the circuit.