(1318) Predictors of Mortality in Patients Undergoing VA ECMO Therapy and Renal Replacement Therapy

Introduction: Given the complexity of ICU patients, (Venoarterial extracorporeal membrane oxygenation) ECMO VA therapy as a bridge to recovery is increasingly common. However, it comes with complications, including 55.6% progressing to acute kidney injury, necessitating RRT in 46%. Controversies exist around prognostic accuracy of protective and/or risk factors impacting outcomes and mortality. Hence, this study aims to identify mortality predictors in VA ECMO patients undergoing RRT at a quaternary care institution.

Methods: This retrospective case study design involved 27 patients admitted to the intensive care unit and requiring V-A ECMO support between January 1, 2019, and May 1, 2023, who progressed to terminal kidney injury requiring RRT. The variables of interest included all values determining protective and/or risk factors associated with mortality. We used a logistic regression model to adjust for confounding and mixed effects variables, validated for patients undergoing RRT with VA-ECMO therapy.

Results: A total of 27 patients were included in the study, of whom 74% (n=20) were male, with a mean age of 48 years (n=15.4), and an associated mortality rate of 44% (n=12). The main etiology of cardiogenic shock was acute coronary syndrome in 8 (29.6%) patients, heart failure in 6 (22%), and sepsis in 4 (14.8%), with a higher mortality rate observed in the group with coronary disease at 33%. Among the presented risk factors, a history of hypertension was associated with an increased mortality risk (OR 14, 95% CI [1.37;142.8], p=0.026), even in the absence of any other associated cardiovascular disease. The initiation of VA-ECMO support therapy at the referral site was found to be a predictor for renal replacement therapy after 30 and 60 days (OR 0.15, 95% CI [0.23;0.99], p=0.05).

Conclusions: Patients on VA-ECMO and RRT exhibit high mortality rates. Various factors are associated with the development of acute renal failure in this patient group. The study suggests that early onset of VA-ECMO support is significantly associated with better outcomes, while a history of hypertension is a risk factor for mortality. Further research is needed to identify factors impacting long-term prognosis, survival, and the discontinuation of RRT in VA-ECMO patients.