The effect of renal dysfunction on mortality rates for patients on VVECMO for ARDS due to COVID-19 infection

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) has been used within the SARS-Cov-2 (COVID-19) pandemic to support patients with severe COVID-19 related acute hypoxemic respiratory failure that is refractory to lung-protective mechanical ventilation. The decision to offer and support patients with ECMO therapy comes from selection criteria which is more likely to demonstrate a positive outcome. However, providers may be faced with challenges regarding discontinuation of therapy when recovery appears unlikely. The in-hospital mortality rate for COVID-19 ECMO patients as reported by ELSO's registry is 47%. This retrospective single-institution study sought to determine the effect of the development of renal dysfunction on mortality rates for COVID-19 ECMO patients. In a cohort of 53 patients, 22 of these patients (41.5%) experienced mortality while receiving ECMO therapy, with a total of 26 (49.1%) experiencing mortality during ECMO therapy or within 90 days after ECMO decannulation. Correlating the outcome of mortality with the stages of severity of AKI as defined by KDIGO guidelines, this study demonstrated a significantly lower percentage of study participants in the No AKI group experienced mortality (12.5%;n=2) relative to all other categories of renal dysfunction, X2(4)=4.96, p<.05. Additionally, bivariate analysis indicated that a significantly higher percentage of study participants who required CRRT experienced mortality (77.8%;n=14) relative to all other categories of renal dysfunction, X2(1)=9.00, p<.01. This demonstrates patients requiring CRRT while on ECMO therapy for ARDS related to COVID-19 are 6.71 times more likely to experience mortality relative to those in other categories.