LAUSR

Learning Objectives: VA-ECMO has become an accepted treatment option for advanced cardiogenic shock, allowing myocardial recovery as well as limiting or even reversing secondary end-organ damage. AKI occurs frequently in patients with cardiogenic shock and predicts poor outcome. However, very little is known about AKI severity and renal recovery and their impact on discharge outcome in patients receiving VA-ECMO for advanced cardiogenic shock. Methods: We analyzed data from 172 VA-ECMO patients without a history of kidney disease. We defined and staged AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine (sCrea) criteria. We scored renal recovery as follows: 0= dependent on renal replacement therapy or discharge KDIGO stage= maximum KDIGO stage, 1=: free from renal replacement therapy or discharge KDIGO stage< maximum KDIGO stage, 2= no episode of AKI or KDIGO stage 0 at discharge. We classified discharge outcome as 0= unfavorable (death/hospice), 1= intermediate (skilled nursing facility/acute care hospital), and 2= favorable (rehabilitation facility/home). We also analyzed standard patient demographics and laboratory markers. Statistical analyses included Wilcoxon test, chi-square test, Fisher’s exact test, and generalized estimating equations (GEE). P <0.05 was considered statistically significant. Results: 58.2% of all patients survived to hospital discharge. AKI occurred in 68.0% of all patients. In 15.1% of all patients, AKI peaked at KDIGO stage 1, in 7.6% at KDIGO stage 2, and in 45.3% at KDIGO stage 3. When adjusted for age, post cardiotomy and post-CPR status, and initial lactate levels, odds ratio for survival to hospital discharge was 0.28 (95% CI, 0.12–0.63) in patients with AKI. GEE further showed that renal recovery stage (p<0.001) but not AKI severity was significantly associated with hospital discharge outcome. Conclusions: AKI is a frequent and severe complication in patients with advanced cardiogenic shock requiring VA-ECMO. Moreover, renal recovery stage, but not maximum AKI severity, shows strong associations with hospital discharge outcomes. This allows us to hypothesize that marker of organ recovery, in particular renal recovery, could become valuable outcome indicators in this patient population. References: 1. Ghodsizad A, Koerner MM et al. Curr Opin Cardiol. 2014; 29:275–280. 2. Tarvasmäki T, Haapio M et al. Eur J Heart Fail. 2017; 3. Kellum JA, Lameire N, Kdigo AKIGWG. Crit Care. 2013; 17:204. CCMCritical Care MedicineCrit Care Med0090-3493Lippincott Williams & WilkinsHagerstown, MD CCM