Brehm, Christoph

AbstractBackgroundVeno‐arterial extracorporeal life support (V‐A ECLS) has become a cornerstone in the management of critical cardiogenic shock, but it can also precipitate organ injury, e.g., acute kidney injury (AKI). Available studies highlight the effect of non‐cardiac organ injury on patient outcomes. Only very little is known about the impact of non‐cardiac organ recovery on patient survival. AKI occurs frequently during cardiogenic shock and carries a poor prognosis. We have developed descriptive models to hypothesize on the role of AKI severity versus that of recovery of renal function for patient survival.MethodsRetrospective, observational study including 175 patients who were successfully decannulated from V‐A ECLS. We assessed AKI severity using the “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria. We defined recovered or preserved renal function (RPRF) prior to decannulation from V‐A ECLS as 0 (AKI with no improvement) or 1 (no AKI or AKI with improvement). We classified patient outcomes as alive or dead at hospital discharge.Results78% (n = 138) of all patients survived hospital discharge of which 38% (n = 67) never developed AKI. After adjusting for shock severity and non‐renal organ injury, RPRF emerged as an independent predictor of survival in both the overall cohort [OR (95% CI) – 4.11 (1.72–9.79)] and the AKI‐only sub‐cohort [OR (95% CI) – 5.18 (1.8–14.92)]. Neither maximum KDIGO stage nor KDIGO stage at the end of V‐A ECLS was independently associated with survival.ConclusionsOur model identifies RPRF, but not AKI severity, as an independent predictor of hospital survival in patients undergoing V‐A ECLS for cardiogenic shock. We hypothesize that recovered or preserved non‐cardiac organ function during V‐A ECLS is crucial for patient survival.