• Alexandre Sitbon, Maxime Coutrot, Santiago Montero, Juliette Chommeloux, Guillaume Lebreton, Florent Huang, Thomas Frapard, Benjamin Assouline, Pineton De ChambrunMarcMAssistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France; Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651 Paris Ced, Guillaume Hekimian, Charles Edouard Luyt, Alain Combes, and Matthieu Schmidt.
• Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 75651, Paris Cedex 13, France.
• J Crit Care. 2023 Dec 1; 78: 154368154368.

PurposeThe impact of VA-ECMO on early renal recovery (within 7 days after ECMO onset) in patients with pre-ECMO acute kidney injury and cardiogenic shock is unknown.Material And MethodsThis retrospective single-center study included adult patients with cardiogenic shock rescued by VA-ECMO and severe AKI occurring before ECMO implantation (pre-ECMO AKI). Patients with early renal recovery (defined as at least a 50% decrease in peak serum creatinine or weaning from renal replacement therapy) were compared to patients without early renal recovery.ResultsDuring 7 years, 145 patients with severe pre-ECMO AKI were included. Eighty-two patients had no early renal recovery whereas 63 had early renal recovery within 7 days after VA-ECMO onset. The median time to early renal recovery was 4 (3,6) days. Nephrotoxic antibiotics (HR = 0.35 [95% CI, 0.21-0.59], p < 0.001), median fluid balance during the first 7 days of VA-ECMO (HR = 0.77 [95% CI, 0.64-0.93], p = 0.008), pre-ECMO AKI stage 3 (HR = 0.36 [95% CI, 0.20-0.64], p < 0.001) and median vasoactive-inotropic score (HR = 0.99 [95% CI, 0.98,1.00], p = 0.035) were independently associated with no early renal recovery.ConclusionsOnly 43% of patients with severe pre-ECMO AKI had early renal recovery after VA-ECMO initiation.Copyright © 2023 Elsevier Inc. All rights reserved.

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