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Kidney Week

Abstract: PO0083

The Impact of AKI on Patients with Out-of-Hospital Cardiac Arrest Managed with Venoarterial Extracorporeal Membrane Oxygenation at the University of Minnesota

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Ravipati, Prasanth, University of Minnesota, Minneapolis, Minnesota, United States
  • Drawz, Paul E., University of Minnesota, Minneapolis, Minnesota, United States
  • Bartos, Jason, University of Minnesota, Minneapolis, Minnesota, United States
  • Murray, Sean, University of Minnesota, Minneapolis, Minnesota, United States
Background

Since 2015, the Minnesota Resuscitation Consortium (MRC) in conjunction with the University of Minnesota medical center have been treating patients who suffer out of hospital refractory ventricular fibrillation/ventricular tachycardia (VF/VT) with a protocolized treatment strategy utilizing mechanical cardiopulmonary support including venoarterial extra corporeal membrane oxygenation (VA ECMO). In this unique and new group of patients, the incidence and clinical impact of acute kidney injury (AKI) and AKI requiring renal replacement therapy (RRT) is not known. Additionally, we observed electrolyte abnormalities in these patients that have not been previously described.

Methods

We conducted a retrospective chart review of patient data obtained via an electronic database created as part of the MRC’s program in conjunction with the health system’s electronic health record. Descriptive statistics were utilized to describe baseline characteristics. We restricted analyses to participants without end stage kidney disease on admission and those who survived at least 24 hours to allow for development of AKI. Kaplan-Meier plots were utilized to show death free survival by AKI category. All analyses were conducted using the R Statistical Computing Environment.

Results

We obtained data for 116 patients in the time period since 2015. Among the 116 patients, 55 patients had AKI defined as doubling of creatinine within 7 days but did not require RRT. Of the remaining 61 patients, 28 developed AKI requiring RRT. Patients who developed
AKI or AKI requiring RRT had a mortality of 70% at 30 days. The remaining 33 patients who did not develop AKI had a mortality of 52% at 30 days. Regarding electrolyte derangements, cooling was associated with hypokalemia and hypophosphatemia with 64% percent of patients
with potassium less than 3 mmol/L and 57% of patients with phosphorus less than 2 mg/dL.

Conclusion

AKI is associated with a high rate of mortality in this unique patient population, and additionally there is marked hypokalemia and hypophosphatemia in the setting of therapeutic cooling. Given the high mortality, this study raises questions regarding optimal treatment strategy for patients who develop AKI, including timing and delivery of RRT and the ideal approach to volume and electrolyte management.