End-stage renal disease should not Be considered a contraindication for veno-arterial extracorporeal membrane oxygenation

Chen-Hsu Pai; Chi-Ling Chen; Chih-Hsien Wang; Nai-Hsin Chi; Shu-Chien Huang; Li-Jung Tseng; Chien-Heng Lai; Hsi-Yu Yu; Nai-Kuan Chou; Ron-Bin Hsu; Yih-Sharng Chen

doi:10.1016/j.jfma.2024.03.012

End-stage renal disease should not Be considered a contraindication for veno-arterial extracorporeal membrane oxygenation

J Formos Med Assoc. 2024 Mar 24:S0929-6646(24)00173-6. doi: 10.1016/j.jfma.2024.03.012. Online ahead of print.

Authors

Affiliations

¹ Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
² Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: wchemail@gmail.com.

PMID: 38527921
DOI: 10.1016/j.jfma.2024.03.012

Abstract

Purpose: This study aims to determine whether end-stage renal disease (ESRD) is a true contraindication for extracorporeal membrane oxygenation in adult patients.

Materials and methods: Adult patients who received VA-ECMO at National Taiwan University Hospital between January 2010 and December 2021 were included. Patients who received regular dialysis before the index admission were included in the ESRD group. The primary outcome was in-hospital mortality.

Results: 1341 patients were included in the analysis, 121 of whom had ESRD before index admission. The ESRD group was older (62.3 versus 56.8 years; P < 0.01) and had more comorbidities. Extracorporeal cardiopulmonary resuscitation (ECPR) was used more frequently in the ESRD group (66.1% versus 51.6%; P < 0.001). The ESRD group had higher in-hospital mortality rates (72.7% versus 63.3%; P = 0.03). In the ECPR subgroup, there was no difference of survival between ESRD and others(P = 0.56). In the multivariate Cox regression, ESRD was not an independent predictor for mortality (P = 0.20).

Conclusions: ESRD was not an independent predictor of in-hospital mortality after VA-ECMO. The survival of ESRD patients was not inferior to those without ESRD when receiving ECPR. Therefore, ESRD should not be considered a contraindication to VA-ECMO in adults.

Keywords: Dialysis; End-stage kidney disease; End-stage renal disease; Extracorporeal cardiopulmonary resuscitation; Extracorporeal life support; Extracorporeal membrane oxygenation.