Jason Thomas, MD
Fellow
San Antonio Uniformed Services-BAMC
Fort Sam Houston, Texas
Disclosure information not submitted.
Anthony Basel, n/a
Intensivist
Brooke Army Medical Center, United States
Disclosure information not submitted.
Title: The Effect of Continuous Renal Replacement Therapy on Survival in ECMO Patients
Introduction: The use of continuous renal replacement therapy (CRRT) in extracorporeal membrane oxygenation (ECMO) patients is associated with increased mortality. However, growing evidence shows a benefit in using CRRT for volume managment. ECMO patients frequently experience hematologic, infectious, or cardiovascular complications that worsen survival. Limited data exist that can explain the correlation between CRRT and increased mortality when exposed to certain complications.
Methods: We performed a single center retrospective review of 235 adult ECMO patients between 2012 and 2021. We compared demographic data and survival to discharge in patients with and without CRRT. Our current data and analysis does not include complications such as infections, major bleeding, thromboses, right heart failure, and persistent renal dysfunction.
Results: CRRT and age were associated with reduced survival to discharge (OR 2.3, p< 0.05 and OR 5.3, p< 0.05 respectively). A burn diagnosis was not associated with reduced survival to discharge (OR 1.9, p=0.13) even though 81.8% of burn patients received CRRT (p< 0.05). Patients who received CRRT spent more days on ECMO (19.9 vs 16.4, p< 0.05). There was no difference in length of stay (37.5 vs 31.3, p=0.12) or ECMO free days (13.7 vs 13.5, p=0.2).
Conclusions: CRRT and age were shown to be negatively associated with survival to discharge. This finding is consistent with past publications. We found that burn-ECMO patients were highly likely to receive CRRT, however a burn diagnosis did not hinder or improve odds of survival to discharge. Multiple confounding factors likely exist. Further analysis is needed to elucidate other factors that are associated with increased mortality in ECMO patients.