(212) Short-Term Renal Outcomes in Children Receiving Extracorporeal Membranous Oxygenation

Introduction: Extracorporeal membranous oxygenation (ECMO) is utilized in critically ill children with refractory cardiac and respiratory failure. Despite improved oxygenation and ventilation, 60% of critically ill adults receiving ECMO develop a Major Adverse Kidney Event (MAKE) by 30 days post-ECMO initiation. This study aimed to investigate the incidence of MAKE in critically ill children receiving ECMO.

Methods: This was a retrospective chart review of children admitted to the neonatal, pediatric, and cardiac intensive care units at a quaternary center between 1/2020 and 1/2023. Serum creatinine was collected daily through 14 days post-ECMO initiation, and acute kidney injury was defined using the KDIGO serum creatinine criteria. The primary outcome was MAKE, defined as >25% decrease in eGFR from baseline, continued need for dialysis, or death at 14 days post-ECMO initiation (MAKE 14). Baseline serum creatinine was the lowest measurement 90 days prior to admission, and if unavailable was calculated using the bedside Schwartz equation and an estimated glomerular filtration rate of 100 ml/min/1.73m^2.

Results: A total of 284 children received ECMO, 227 (80%) VA. Median age was 8 months (0-85), weight was 7 kg (3-25), and ECMO duration was 7 days (4-12). MAKE 14 occurred in 114 (40%) patients. Hispanic race (OR: 0.18 CI: 0.03-0.83) and a lack of ECMO complications (0.44, 0.25-0.76) were associated with decreased odds of MAKE 14. ECMO indication (1.18, [1.02 - 1.37]), CPR before ECMO (2.57, [1.31 - 5.17]), and longer AKI duration (1.36, [1.26 - 1.47]) were associated with increased odds of MAKE 14. ECMO complications associated with higher MAKE 14 occurrence included hemorrhagic (2.03, [1.23 - 3.37]), pulmonary (2.30, [1.16 - 4.67]), and metabolic (5.34, [1.83 - 19.37]) .

Conclusions: In this single center retrospective study, 40% of children developed MAKE 14, which was associated with hemorrhagic, pulmonary, and metabolic ECMO complications. Future studies should further investigate the timing and impact of ECMO complications on the development of AKI, and identify modifiable factors and long-term renal complications within this vulnerable population.