Cardiogenic shock (CS) is a life-threatening syndrome characterized by peripheral hypoperfusion and organ dysfunction caused by primary heart disease. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a temporary mechanical circulatory support device for CS, used in cases of profound shock, biventricular failure, respiratory failure, and cardiac arrest that require urgent maximal support. While VA-ECMO provides effective tissue perfusion and ensures oxygen supply to organs, it is also associated with severe complications, among which acute kidney injury (AKI) is one of the most common and serious. To date, no comprehensive review has been conducted on the pathophysiology, influencing factors, and treatment of AKI associated with VA-ECMO. This paper aims to elaborate on the pathophysiological mechanisms, influencing factors, and treatment options for AKI in patients with CS undergoing VA-ECMO, providing clinical and nursing references.
Lorusso R, Shekar K, MacLaren G, et al., 2021, ELSO Interim Guidelines for Venoarterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients. ASAIO J, 67(8): 827–844. https://doi.org/10.1097/MAT.0000000000001510. Erratum in ASAIO J, 68(7): e133. https://doi.org/10.1097/MAT.0000000000001725
Pineton de Chambrun M, Bréchot N, Combes A, 2018, Mechanical Circulatory Devices in Acute Heart Failure. Curr Opin Crit Care, 24(4): 286–291. https://doi.org/10.1097/MCC.0000000000000520
Toto F, Torre T, Theologou T, et al., 2020, Are There Mortality Risk Predictors in Myocardial Infarction and Cardiogenic Shock Treated by Extracorporeal Life Support? Kardiovaskulare Medizin, 23(Suppl 28): 37S.
Chakaramakkil MJ, Sivathasan C, 2021, ECMO in Cardiogenic Shock and Bridge to Heart Transplant. Indian J Thorac Cardiovasc Surg, 37(Suppl 2): 319–326. https://doi.org/10.1007/s12055-020-00923-2
Extracorporeal Life Support Organization (ELSO), Live Registry Dashboard of ECMO Patient Data, viewed June 14, 2023, https://www.elso.org/registry/elsoliveregistrydashboard.aspx
Al-Jaghbeer M, Dealmeida D, Bilderback A, et al., 2018, Clinical Decision Support for In-Hospital AKI. J Am Soc Nephrol, 29(2): 654–660. https://doi.org/10.1681/ASN.2017070765
Tarvasmäki T, Haapio M, Mebazaa A, et al., 2018, Acute Kidney Injury in Cardiogenic Shock: Definitions, Incidence, Haemodynamic Alterations, and Mortality. Eur J Heart Fail, 20(3): 572–581. https://doi.org/10.1002/ejhf.958
Lepère V, Duceau B, Lebreton G, et al., 2020, Risk Factors for Developing Severe Acute Kidney Injury in Adult Patients With Refractory Postcardiotomy Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation. Crit Care Med, 48(8): e715–e721. https://doi.org/10.1097/CCM.0000000000004433
Wang L, Chen L, Ni H, et al., 2022, Development of An Acute Kidney Injury Risk Prediction Model for Patients Undergoing Extracorporeal Membrane Oxygenation. Heliyon, 8(12): e12585. https://doi.org/10.1016/j.heliyon.2022.e12585
Thongprayoon C, Cheungpasitporn W, Lertjitbanjong P, et al., 2019, Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis. J Clin Med, 8(7): 981. https://doi.org/10.3390/jcm8070981
Mou Z, He J, Guan T, et al., 2022, Acute Kidney Injury During Extracorporeal Membrane Oxygenation: VA ECMO Versus VV ECMO. J Intensive Care Med, 37(6): 743–752. https://doi.org/10.1177/08850666211035323
Sakhuja A, McCarthy P, Hayanga JA, et al., 2022, Acute Kidney Injury in Extracorporeal Membrane Oxygenation Patients: National Analysis of Impact of Age. Blood Purif, 51(7): 567–576. https://doi.org/10.1159/000518346
Vinclair C, De Montmollin E, Sonneville R, et al., 2020, Factors Associated with Major Adverse Kidney Events in Patients who Underwent Veno-Arterial Extracorporeal Membrane Oxygenation. Ann Intensive Care, 10(1): 44. https://doi.org/10.1186/s13613-020-00656-w
Chiravuri SD, Riegger LQ, Christensen R, et al., 2011, Factors Associated with Acute Kidney Injury or Failure in Children Undergoing Cardiopulmonary Bypass: A Case-Controlled Study. Paediatr Anaesth, 21(8): 880–886. https://doi.org/10.1111/j.1460-9592.2011.03532.x
Hu Y, Yu W, Shi J, et al., 2013, Effects of Continuous Renal Replacement Therapy on Renal Inflammatory Cytokines During Extracorporeal Membrane Oxygenation in A Porcine Model. J Cardiothorac Surg, 8: 113. https://doi.org/10.1186/1749-8090-8-113
Cerdá J, 2015, Acute Kidney Injury During Extracorporeal Membrane Oxygenation: Timing and Fluid Overload May Be Important Determinants of Outcome. Crit Care Med, 43(9): 2028–2029. https://doi.org/10.1097/CCM.0000000000001172
Askenazi DJ, Selewski DT, Paden ML, et al., 2012, Renal Replacement Therapy in Critically Ill Patients Receiving Extracorporeal Membrane Oxygenation. Clin J Am Soc Nephrol, 7(8): 1328–1336. https://doi.org/10.2215/CJN.12731211
Ostermann M, Lumlertgul N, 2021, Acute Kidney Injury in ECMO Patients. Crit Care, 25(1): 313. https://doi.org/10.1186/s13054-021-03676-5. Erratum in Crit Care, 28(1): 110. https://doi.org/10.1186/s13054-024-04857-8
Husain-Syed F, Ricci Z, Brodie D, et al., 2018, Extracorporeal Organ Support (ECOS) in Critical Illness and Acute Kidney Injury: From Native to Artificial Organ Crosstalk. Intensive Care Med, 44(9): 1447–1459. https://doi.org/10.1007/s00134-018-5329-z
Bridges BC, Dhar A, Ramanathan K, et al., 2022, Extracorporeal Life Support Organization Guidelines for Fluid Overload, Acute Kidney Injury, and Electrolyte Management. ASAIO Journal, 68(5): 611–618. https://doi.org/10.1097/mat.0000000000001702
Chehab O, Pahuja M, Mansour S, et al., 2020, In-Hospital Mortality, Acute Kidney Injury, Length of Stay and Cost among Patients with Acute Myocardial Infarction Related Cardiogenic Shock Complicated with Nosocomial Infections: Analysis of National Inpatient Sample Data. Journal of Heart and Lung Transplantation, 39(4): S200–S201. https://doi.org/10.1016/j.healun.2020.01.808
Singh S, Kanwar A, Sundaragiri PR, et al., 2021, Acute Kidney Injury in Cardiogenic Shock: An Updated Narrative Review. J Cardiovasc Dev Dis, 8(8): 88. https://doi.org/10.3390/jcdd8080088
Han SJ, Lee HT, 2019, Mechanisms and Therapeutic Targets of Ischemic Acute Kidney Injury. Kidney Res Clin Pract, 38(4): 427–440. https://doi.org/10.23876/j.krcp.19.062
Ootaki C, Yamashita M, Ootaki Y, et al., 2008, Reduced Pulsatility Induces Periarteritis in Kidney: Role of the Local Renin-Angiotensin System. J Thorac Cardiovasc Surg, 136(1): 150–158. https://doi.org/10.1016/j.jtcvs.2007.12.023
Kilburn DJ, Shekar K, Fraser JF, 2016, The Complex Relationship of Extracorporeal Membrane Oxygenation and Acute Kidney Injury: Causation or Association? Biomed Res Int, 2016: 1094296. https://doi.org/10.1155/2016/1094296
McIlwain RB, Timpa JG, Kurundkar AR, et al., 2010, Plasma Concentrations of Inflammatory Cytokines Rise Rapidly During ECMO-Related SIRS Due to the Release of Preformed Stores in the Intestine. Lab Invest, 90(1): 128–139. https://doi.org/10.1038/labinvest.2009.119
Mu TS, Palmer EG, Batts SG, et al., 2012, Continuous Renal Replacement Therapy to Reduce Inflammation in A Piglet Hemorrhage-Reperfusion Extracorporeal Membrane Oxygenation Model. Pediatr Res, 72(3): 249–255. https://doi.org/10.1038/pr.2012.69
Ricci Z, Pezzella C, Romagnoli S, et al., 2014, High Levels of Free Haemoglobin in Neonates and Infants Undergoing Surgery on Cardiopulmonary Bypass. Interact Cardiovasc Thorac Surg, 19(2): 183–187. https://doi.org/10.1093/icvts/ivu129
Villa G, Katz N, Ronco C, 2015, Extracorporeal Membrane Oxygenation and the Kidney. Cardiorenal Med, 6(1): 50–60. https://doi.org/10.1159/000439444
Chen W, Pei M, Chen C, et al., 2023, Independent Risk Factors of Acute Kidney Injury Among Patients Receiving Extracorporeal Membrane Oxygenation. BMC Nephrol, 24(1): 81. https://doi.org/10.1186/s12882-023-03112-6
Lou S, MacLaren G, Best D, et al., 2014, Hemolysis in Pediatric Patients Receiving Centrifugal-Pump Extracorporeal Membrane Oxygenation: Prevalence, Risk Factors, and Outcomes. Crit Care Med, 42(5): 1213–1220. https://doi.org/10.1097/CCM.0000000000000128
Vaynrub A, Ning Y, Kurlansky P, et al., 2023, Acute Kidney Injury During Extracorporeal Life Support in Cardiogenic Shock: Does Flow Matter? Perfusion, 2676591231220793 (online ahead of print). https://doi.org/10.1177/02676591231220793
Liao XZ, Cheng Z, Wang LQ, et al., 2018, Risk Factors for Acute Renal Failure During Extracorporeal Membrane Oxygenation. Journal of Clinical Anesthesiology, 34(3): 241–245.
Zhao LM, 2020, Analysis of Risk Factors for Acute Kidney Injury Induced by Extracorporeal Membrane Oxygenation, dissertation, Henan University.
Coelho FUA, Gadioli B, Freitas FFM, et al., 2023, Factors Associated with Acute Kidney Injury in Patients Undergoing Extracorporeal Membrane Oxygenation: Retrospective Cohort. Rev Esc Enferm USP, 57: e20220299. https://doi.org/10.1590/1980-220X-REEUSP-2022-0299en
Kashani K, Al-Khafaji A, Ardiles T, et al., 2013, Discovery and Validation of Cell Cycle Arrest Biomarkers in Human Acute Kidney Injury. Crit Care, 17(1): R25. https://doi.org/10.1186/cc12503
Parikh CR, Mishra J, Thiessen-Philbrook H, et al., 2006, Urinary IL-18 is An Early Predictive Biomarker of Acute Kidney Injury After Cardiac Surgery. Kidney Int, 70(1): 199–203. https://doi.org/10.1038/sj.ki.5001527
Patel UD, Garg AX, Krumholz HM, et al., 2012, Preoperative Serum Brain Natriuretic Peptide and Risk of Acute Kidney Injury After Cardiac Surgery. Circulation, 125(11): 1347–55. https://doi.org/10.1161/CIRCULATIONAHA.111.029686
Vanmassenhove J, Vanholder R, Nagler E, et al., 2013, Urinary and Serum Biomarkers for the Diagnosis of Acute Kidney Injury: An In-Depth Review of the Literature. Nephrol Dial Transplant, 28(2): 254–273. https://doi.org/10.1093/ndt/gfs380
Zhang Z, Lu B, Sheng X, et al., 2011, Cystatin C in Prediction of Acute Kidney Injury: A Systemic Review and Meta-Analysis. Am J Kidney Dis, 58(3): 356–365. https://doi.org/10.1053/j.ajkd.2011.02.389. Erratum in Am J Kidney Dis, 59(4): 590–592.
Li ZJ, Wu S, Li C, 2022, Predictive Value of Serum CysC, NGAL, and KIM-1 for Acute/Chronic Renal Failure and Death in Patients with Veno-Arterial Extracorporeal Membrane Oxygenation. Chin J Lab Med, 43(19): 2321–2326.
Qiao X, Swain L, Reyelt L, et al., 2019, VA-ECMO Increases Urinary Levels of the Biomarker Kidney Injury Marker-1 (KIM-1) in A Preclinical Model of Acute Myocardial Infarction. Circulation Research, 125(Suppl 1).
Ding XC, Xie HX, Yang F, et al., 2019, Relationship Between Model-Derived Scores of End-Stage Liver Disease and Extracorporeal Membrane Oxygenation-Assisted Acute Renal Function Injury in Adult Patients After Cardiac Surgery. Chinese Journal of Cardiopulmonary Bypass, 17(1): 8–12.
Worku B, Khin S, Gaudino M, et al., 2021, Renal Replacement Therapy in Patients on Extracorporeal Membrane Oxygenation Support: Who and How. Int J Artif Organs, 44(8): 531–538. https://doi.org/10.1177/0391398820980451