Abstract 13712: Clinical Predictive Tool for Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation Therapy and Ultrafiltration

Abstract

Introduction: Fluid overload is common among pediatric cardiac patients receiving ECMO. It is often treated with in-line ultrafiltration (UF) with some patients progressing to continuous renal replacement therapy (CRRT). We assessed whether requiring CRRT was associated with increased morbidity and mortality compared to UF alone. Additionally, we evaluated characteristics associated with the progression from UF to CRRT to create a clinical decision support tool to help identify patients likely to require CRRT. Hypothesis: Pediatric cardiac patients on ECMO who require CRRT have increased morbidity and mortality compared to UF alone and can be identified at the time UF is initiated. Methods: Retrospective chart review of patients age ≤18 years treated with ECMO from 1/14-12/19 at a single quaternary care cardiac ICU. Bivariate comparisons using Chi-square or Fisher’s Exact and Mann-Whitney U tests were used as appropriate. ROC curve was used to create a tool predictive of the need for CRRT at the time of initiation of UF. Results: Of 131 ECMO patients, 45 (32%) underwent UF and 13 (10%) UF then CRRT. Patients who required CRRT had a higher creatinine and BUN at time of UF initiation (p=0.04 and p=<0.01), longer time on ECMO (p=<0.01), a lower rate of renal recovery (p=0.02), and higher mortality (p=0.01). Using ROC analysis, presence of ≤3 of 7 variables (BUN >20 and GFR <60 at UF initiation, low MAP and RPP 12 hours before initiation of UF, total fluid overload > 10%, daily fluid balance > 50mL/kg in the 24 hours prior to UF initiation, and urine output <1ml/kg/hr in the day prior to UF initiation) had a positive predictive value of 87.5% and negative predictive value of 50.0% for the use of UF alone (AUC 0.801; p=0.002). Conclusions: Pediatric cardiac patients treated with ECMO and UF who require CRRT demonstrate increased morbidity and mortality compared to UF alone. A novel clinical tool may assist in stratifying patients at UF initiation.