(1332) Factors Associated With Mortality Risk in Critical Care Patients With Venovenous ECMO and RRT

Introduction: Acute Respiratory Distress Syndrome (ARDS) is a severe medical condition characterized by acute lung inflammation and profound respiratory dysfunction, resulting in refractory hypoxemia. Veno-venous Extracorporeal Membrane Oxygenation (VV ECMO) is a supportive therapy used in severe ARDS cases that do not respond to conventional treatments. However, the application of this support requires extreme caution due to its complexity and potential complications. About 21% to 70% of ARDS patients receiving VV ECMO therapy may require renal replacement therapy (RRT). This study aims to identify mortality risk factors in patients diagnosed with ARDS, undergoing RRT, and receiving VV ECMO support at a quaternary care institution.

Methods: This study is an analytical observational retrospective cohort study that analyzed 43 patients admitted to the intensive care unit requiring VV ECMO support from January 1, 2019, to May 1, 2023, and subsequently developing renal injury necessitating RRT. The variables of interest included factors associated with mortality, both protective and risky. To account for confounding variables and mixed effects, a logistic regression model was utilized and validated for patients undergoing RRT with VV ECMO support.

Results: The study included 43 patients, of whom 58.1% (n=25) were male, with a mean age of 41 years (n=13.5), and an associated mortality rate of 48.8% (n=21). The primary etiology of ARDS was direct lung injury. Risk factors associated with higher mortality included patient-related factors such as advanced age with an Odds Ratio (OR) of 1.05 (95% CI 1.0 - 1.11) and male gender with an OR of 3.0 (95% CI 0.84 - 1.06). Disease-related factors before cannulation included longer duration of invasive mechanical ventilation with an OR of 1.03 (95% CI 0.98 - 10.09), the need for dual vasopressor support with an OR of 2.5 (95% CI 0.68 - 9.54), elevated driving pressure with an OR of 1.0 (95% CI 0.84 - 1.02), and higher oxygen debt with an OR of 1.09 (95% CI 0.94 - 1.0).

Conclusions: This study highlights the importance of careful and specialized care for critically ill patients receiving VV ECMO and TRR. It underscores the need for a thorough evaluation of factors associated with mortality to enhance management and treatment in intensive care units