Next Article in Journal
The Effects of Iloprost on Oxygenation During One-Lung Ventilation for Lung Surgery: A Randomized Controlled Trial
Next Article in Special Issue
The Predictive Value of Hyperuricemia on Renal Outcome after Contrast-Enhanced Computerized Tomography
Previous Article in Journal
Rehabilitation of Neonatal Brachial Plexus Palsy: Integrative Literature Review
Previous Article in Special Issue
Incidence and Cost of Acute Kidney Injury in Hospitalized Patients with Infective Endocarditis
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 8
Issue 7
10.3390/jcm8070981
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

by
Charat Thongprayoon
1,
Wisit Cheungpasitporn
2,
Ploypin Lertjitbanjong
3,
Narothama Reddy Aeddula
4,
Tarun Bathini
5,
Kanramon Watthanasuntorn
3,
Narat Srivali
6,
Michael A. Mao
7 and
Kianoush Kashani
1,8,*
1
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
2
Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
3
Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, USA
4
Division of Nephrology, Department of Medicine, Deaconess Health System, Evansville, IN 47747, USA
5
Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA
6
Division of Pulmonary and Critical Care Medicine, St. Agnes Hospital, Baltimore, MD 21229, USA
7
Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA
8
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(7), 981; https://doi.org/10.3390/jcm8070981
Submission received: 15 May 2019 / Revised: 23 June 2019 / Accepted: 2 July 2019 / Published: 5 July 2019
(This article belongs to the Special Issue Diagnostics, Risk Factors, Treatment and Outcomes of Acute Kidney Injury in a New Paradigm)
Browse Figures
Review Reports Versions Notes

Abstract

:
Background: Although acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. Methods: A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). Results: 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%–72.4%) and 44.9% (95%CI: 40.8%–49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87–4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21–4.99). There was no publication bias as evaluated by the funnel plot and Egger’s regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Conclusion: Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.

1. Introduction

Extracorporeal membrane oxygenation (ECMO), as a mechanical circulatory support system, is utilized as a treatment for cardiovascular or respiratory failure [1,2,3]. There are two main types of ECMO, including venovenous (VV)-ECMO for patients with isolated respiratory failure and venoarterial (VA)-ECMO for combined severe cardiac and respiratory failure [4]. Over the past 40 years, the clinical applications and feasibility of ECMO have expanded in patients with refractory cardiorespiratory failure, and there has been an exponential increase in the number of centers utilizing ECMO globally [3,5,6,7,8,9]. Studies have demonstrated survival benefits of ECMO ranging from 20% to 50% in patients with cardiac arrest, severe adult respiratory distress syndrome (ARDS), and refractory cardiogenic shock [5,10,11,12,13,14,15,16].
Despite these benefits, there have been a number of reports to highlight the concomitant occurrence of organ failures and complications including acute kidney injury (AKI), infections, thrombosis, bleeding and coagulopathy, and neurological events [17,18]. The underlying mechanisms for AKI among patients requiring ECMO appear to be complex and include hemodynamic instabilities, inflammatory responses, coagulation-platelet abnormalities, and immune-mediated injury that arise from the primary underlying disease, premorbid conditions and the ECMO circuit [18,19,20,21,22,23,24,25,26,27,28]. Due to previously non-uniform definitions of AKI, the reported incidences of AKI among patients requiring ECMO therapy ranged widely from 8% up to 85% [4,7,15,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70]. In addition, the incidence and mortality associated with AKI in patients requiring ECMO and their trends remain unclear.
This systematic review was conducted with the aim to summarize the incidence (using standard AKI definitions) and the impact of AKI on mortality risk among adult patients on ECMO.

2. Methods

2.1. Information Sources and Search Strategy

The protocol for this systematic review and meta-analysis is registered with International Prospective Register of Systematic Reviews (PROSPERO no. CRD42018103527). A systematic literature review of EMBASE, Ovid MEDLINE, and the Cochrane Database of Systematic Reviews from database inception through March 2019 was conducted to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. Two authors (C.T. and W.C.) independently performed a systematic literature search utilizing a search approach that consolidated the search terms “extracorporeal membrane oxygenation” OR “ECMO” AND “acute kidney injury” OR “acute renal failure.” Further details regarding the search strategy utilized for each database are provided in Online Supplementary Data 1. No language restriction was implemented. A manual search for conceivably related articles utilizing references of the included studies was additionally performed. This systematic review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement [71].

2.2. Study Selection

Studies were included in this systematic review if they were clinical trials or observational studies that reported the incidence of AKI (using standard AKI definitions including RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) [72], AKIN (Acute Kidney Injury Network) [73], and KDIGO (Kidney Disease: Improving Global Outcomes) classifications) [74], severe AKI requiring renal replacement therapy (RRT), and mortality risk of AKI among adult patients (age ≥ 18 years old) on ECMO. Eligible studies needed to provide the data to evaluate the incidence or mortality rate of AKI with 95% confidence intervals (CI). Retrieved articles were independently examined for eligibility by the two authors (C.T. and W.C.). Inconsistencies were discussed and resolved by shared agreement. The size of the study did not limit inclusion.

2.3. Data Collection Process

A structured data collecting form was adopted to gather the following data from individual study including title, name of authors, publication year, year of the study, country where the study was conveyed, type of ECMO, AKI definition, incidence of AKI, incidence of severe AKI requiring RRT, and mortality risk of AKI among patients on ECMO.

2.4. Statistical Analysis

We used the Comprehensive Meta-Analysis software version 3.3.070 (Biostat Inc, Englewood, NJ, USA) to conduct the meta-analysis. Adjusted point estimates of included studies were consolidated by the generic inverse variance method of DerSimonian-Laird, which assigned the weight of individual study based on its variance [75]. Due to the probability of between-study variance, we applied a random-effects model to pool outcomes of interest, including the incidence of AKI and mortality risk. Statistical heterogeneity of studies was assessed by the Cochran’s Q test (p < 0.05 for a statistical significance) and the I2 statistic (≤25%: insignificant heterogeneity, 26%–50%: low heterogeneity, 51%–75%: moderate heterogeneity and ≥75%: high heterogeneity) [76]. The presence of publication bias was evaluated by both the funnel plot and the Egger test [77].

3. Results

A total of 1,632 potentially eligible articles were identified with our search approach. After excluding 644 articles that were either in-vitro studies, focused on pediatric patient population, animal studies, case reports, correspondences, or review articles, and 831 articles due to being duplicates, 157 articles remained for full-length article review. Seventy-three articles were subsequently excluded as they did not provide data on the incidence of AKI or mortality of AKI, while 33 articles were excluded because they were not clinical trials or observational studies. Ten studies [19,20,21,22,23,24,25,26,27,28] were additionally excluded because they did not use a standard AKI definition or did not report the incidence of severe AKI requiring RRT. Therefore, 41 cohort studies [7,15,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67] with a total of 10,282 adult patients receiving ECMO were enrolled. The systematic review of the literature flowchart is demonstrated in Figure 1. The characteristics of the included studies are shown in Table 1.

3.1. Incidence of AKI in Patients Requiring ECMO

Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT while on ECMO were 62.8% (95%CI: 52.1%–72.4%, I2 = 94%, Figure 2A) and 44.9% (95%CI: 40.8%-49.0%, I2 = 91%, Figure 2B), respectively. Subgroup analyses were performed according to AKI definitions. The pooled estimated incidence rates of AKI by RIFLE, AKIN, and KDIGO criteria were 67.5% (95%CI: 43.9%–84.6%, I2 = 85%), 57.8% (95%CI: 44.6%–70.0%, I2 = 86%), and 68.2% (95%CI: 43.8%–85.55%, I2 = 98%), respectively.
Subgroup analysis based on the type of ECMO was also performed. Pooled estimated incidence of AKI and severe AKI requiring RRT while on venoarterial (VA)-ECMO were 60.8% (95%CI: 32.9%–83.1%, I2 = 96%) and 49.5% (95%CI: 39.6%–59.4%, I2 = 90%), respectively. Pooled estimated incidence of AKI and severe AKI requiring RRT while on venovenous (VV)-ECMO were 45.7% (95%CI: 33.2%–58.8%, I2 = 47%) and 37.0% (95%CI: 14.8%–66.5%, I2 = 95%), respectively. Meta-regression showed that year of the study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83), as shown in Figure 3.

3.2. AKI associated Mortality in Patients Requiring ECMO

Mortality rate and mortality risk associated with AKI in patients requiring ECMO are demonstrated in Table 1 and Table 2, respectively. The pooled estimated hospital and/or 90-day mortality rates of patients with AKI and severe AKI requiring RRT while on ECMO were 62.0% (95%CI: 54.7%–68.8%, I2 = 73%, Figure 4A) and 68.4% (95%CI: 62.6%–73.6%, I2 = 87%, Figure 4B), respectively.
The pooled OR of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87–4.85, I2 = 62%, Figure 5A). When the analysis was limited to studies with confounder-adjusted analysis, the increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21–4.99, I2 = 82%, Figure 5B).
Meta-regression showed that year of the study did not significantly affect hospital mortality among patients receiving ECMO with AKI requiring RRT (p = 0.86), as shown in Figure 6.

3.3. Evaluation for Publication Bias

Funnel plots (Figure 7) and Egger’s regression asymmetry tests were utilized to assess for publication bias in our meta-analyses evaluating the incidence of AKI and severe AKI requiring RRT while on ECMO. There was no publication bias as determined by the funnel plot and Egger’s regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively.

4. Discussion

The findings of our meta-analysis demonstrate that patients who required ECMO had incidence rates of AKI (using standard AKI definitions) and severe AKI requiring RRT of 62.8% and 44.9%, respectively. Moreover, patients with AKI and severe AKI requiring RRT had high associated mortality rates of 62.0% and 68.4%, respectively.
Although the mechanisms underlying ECMO associated-AKI remains unclear, it is likely complex and multifactorial, including contributing factors such as primary disease progression, altered hemodynamics, low cardiac output syndrome, exposure to nephrotoxic agents (for management of underlying diseases), new-onset sepsis, high intrathoracic pressures, fluid overload, ischemia-reperfusion injury, release of proinflammatory mediators and oxidative stress, hemolysis and iron-mediated (hemoglobin-induced) renal injury, and hypercoagulable state resulting in renal microembolisms [4,8,68,78,79]. Studies have demonstrated the activation of proinflammatory mediators such as tumor necrosis factor-alpha (TNF-α), interleukins (e.g., IL-1β, IL-6, IL-8) and other cytokine signaling cascades due to the continuous exposure of blood to non-biological and non-endothelialized ECMO interface [68,80,81]. Activation of the inflammatory cascades can result in hyperdynamic vasodilated hypotensive states, leading to AKI [68,78].
Following the initiation of ECMO treatment, there are improvements in oxygenation and oxygen consumption as well as hemodynamics [3,5,6,7,8,9]. However, ischemia-reperfusion injury can also occur after the restoration of circulation to previously hypoxic cells and hypoperfused organs, leading to the production of reactive oxygen species (ROS) and oxidative stress-mediated injury [68,78]. In addition, ECMO-associated complications or adverse effects such as hemolysis, hemorrhage or thrombosis also can play important roles in the development of AKI [29,68,82,83,84]. Despite the advance of a new miniaturized ECMO system, hemolysis due to shear stress from the ECMO circuit has been reported among ECMO patients with incidences between 5% and 18% [17,85,86,87]. This can contribute to heme pigment-induced AKI [83,84]. Although improvements in the ECMO technology have led to less thrombus development in its circuit with an improved capacity of the circuit to remove large emboli [68,82], smaller thrombi can still develop and result in renal microembolism [68,82], particularly with VA-ECMO [82].
The type of ECMO may also differently affect AKI risk. Our study demonstrated a higher incidence of AKI among patients requiring VA-ECMO (60.8%) than those requiring VV-ECMO (45.7%). While VV-ECMO is typically utilized for patients with isolated respiratory failure, VA-ECMO is used for combined severe cardiac and respiratory failure [4]. In VA-ECMO, there is a mixture of pulsatile arterial flow from the native heart and non-pulsatile arterial flow from the ECMO pump. Conversely, VV-ECMO maintains pulsatile cardiac output, and alterations in renal perfusion may conceivably be smaller [4]. Recent studies have shown that pulsatile flow may provide beneficial effects over non-pulsatile flow, especially protective effects on microcirculation and renal perfusion [88,89,90]. The differences in patient population and pulsatility between the two types of ECMO are likely explanations underlying the higher AKI incidence among patients requiring VA-ECMO.
As there is no treatment available for AKI, management of AKI is limited to appropriate secondary preventive measures and supportive strategies [91,92,93,94,95,96]. RRT in the form of continuous renal replacement therapy (CRRT) is often required among patients requiring ECMO with severe AKI [42,55,97]. Our study demonstrated no significant correlation between the year of study and the incidence of AKI and/or severe AKI requiring RRT despite considerable changes in technology and practice of ECMO among adult patients. Furthermore, we showed a 3.7-fold increased risk of hospital mortality among ECMO patients with severe AKI requiring RRT. Thus, prevention and early identification of AKI among patients at-risk of ECMO-associated AKI could potentially play a crucial role in improved survival. Studies have shown several important AKI risk factors among patients requiring ECMO including older age, elevated lactate levels before ECMO initiation, high dose of inotropic drugs, severely reduced left ventricular ejection fraction, cirrhosis, postcardiotomy shock as an indication for ECMO, and finally ECMO pump speed and its duration [56,64,67]. Lee et al. recently observed a lower AKI association with a higher ECMO pump speed [56]. Although the underlying pathophysiology remains unclear, excessive ECMO pump speed has been shown to induce hemolysis and complement activation in vitro and animal model [98,99]. In pediatric patients receiving ECMO, Lou et al. also demonstrated higher pump speeds are associated with hemolysis and a number of other adverse clinical outcomes [100]. To prevent hemolysis-mediated kidney injury, it is suggested to limit pump revolutions/min (RPM) to safe levels (i.e., 3000 to 3500 RPM) in order to avoid excessive negative pressures generated within the pump [101]. Future prospective studies are required to assess the effects of ECMO pump speed on AKI risk in ECMO patients. In addition, future studies creating risk prediction models for ECMO-associated AKI are needed to assist with the prevention of AKI in a timely manner, which could potentially lead to an improvement in patient survival.
Our study has several limitations. Firstly, there are statistical heterogeneities in our meta-analysis. Potential sources for heterogeneities were the variations in patient characteristics among the included studies. However, we performed subgroup analysis to assess the AKI incidence based on types of ECMO and a separate meta-analysis that only included studies with confounder-adjusted analysis for mortality risk. Another limitation was that AKI diagnosis was mainly based on serum creatinine [102,103,104] while the data on urine output and novel biomarkers for AKI [105,106,107,108] were limited. Lastly, this systematic review is primarily based on observational studies, as the data from clinical trials or population-based studies were limited. Therefore, it can at best, demonstrate an association but not a causal relationship.

5. Conclusions

In conclusion, there is an overall high incidence of AKI and severe AKI requiring RRT in ECMO patients of 62.8% and 44.9%, respectively. The incidence of ECMO-associated AKI has not changed over time. AKI requiring RRT while on ECMO is associated with 3.7-fold increased risk of hospital mortality. Future studies should focus on strategies for prediction, detection, and prevention of AKI among patients who receive ECMO.

Supplementary Materials

The following are available online at https://www.mdpi.com/2077-0383/8/7/981/s1.

Author Contributions

Conceptualization, C.T., W.C., M.A.M. and K.K.; Data curation, C.T., W.C. and P.L.; Formal analysis, C.T., W.C.; Funding acquisition, K.K.; Investigation, C.T., W.C., P.L. and K.K.; Methodology, C.T., W.C. and K.K.; Project administration, P.L., K.W. and N.S.; Resources, P.L., T.B. and K.W.; Software, K.W.; Supervision, M.A.M. and K.K.; Validation, W.C. and P.L.; Visualization, W.C., T.B. and K.K.; Writing – original draft, C.T. and N.R.A; Writing – review & editing, C.T., W.C., P.L., N.R.A., T.B., K.W., N.S., M.A.M. and K.K.

Conflicts of Interest

The authors deny any conflict of interest.

References

  1. Guru, P.K.; Singh, T.D.; Passe, M.; Kashani, K.B.; Schears, G.J.; Kashyap, R. Derivation and Validation of a Search Algorithm to Retrospectively Identify CRRT Initiation in the ECMO Patients. Appl. Clin. Inform. 2016, 7, 596–603. [Google Scholar] [CrossRef] [PubMed]
  2. Hill, J.D.; O’Brien, T.G.; Murray, J.J.; Dontigny, L.; Bramson, M.L.; Osborn, J.J.; Gerbode, F. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N. Engl. J. Med. 1972, 286, 629–634. [Google Scholar] [CrossRef] [PubMed]
  3. Peek, G.J.; Mugford, M.; Tiruvoipati, R.; Wilson, A.; Allen, E.; Thalanany, M.M.; Hibbert, C.L.; Truesdale, A.; Clemens, F.; Cooper, N.; et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): A multicentre randomised controlled trial. Lancet 2009, 374, 1351–1363. [Google Scholar] [CrossRef]
  4. Chen, Y.C.; Tsai, F.C.; Fang, J.T.; Yang, C.W. Acute kidney injury in adults receiving extracorporeal membrane oxygenation. J. Formos. Med. Assoc. 2014, 113, 778–785. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  5. Thiagarajan, R.R.; Barbaro, R.P.; Rycus, P.T.; Mcmullan, D.M.; Conrad, S.A.; Fortenberry, J.D.; Paden, M.L. Extracorporeal Life Support Organization Registry International Report 2016. ASAIO J. 2017, 63, 60–67. [Google Scholar] [CrossRef] [PubMed]
  6. Paden, M.L.; Conrad, S.A.; Rycus, P.T.; Thiagarajan, R.R. Extracorporeal Life Support Organization Registry Report 2012. ASAIO J. 2013, 59, 202–210. [Google Scholar] [CrossRef]
  7. Schmidt, M.; Bailey, M.; Kelly, J.; Hodgson, C.; Cooper, D.J.; Scheinkestel, C.; Pellegrino, V.; Bellomo, R.; Pilcher, D. Impact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation. Intensive Care Med. 2014, 40, 1256–1266. [Google Scholar] [CrossRef]
  8. Hamdi, T.; Palmer, B.F. Review of Extracorporeal Membrane Oxygenation and Dialysis-Based Liver Support Devices for the Use of Nephrologists. Am. J. Nephrol. 2017, 46, 139–149. [Google Scholar] [CrossRef] [Green Version]
  9. Husain-Syed, F.; Ricci, Z.; Brodie, D.; Vincent, J.L.; Ranieri, V.M.; Slutsky, A.S.; Taccone, F.S.; Gattinoni, L.; Ronco, C. Extracorporeal organ support (ECOS) in critical illness and acute kidney injury: From native to artificial organ crosstalk. Intensive Care Med. 2018, 44, 1447–1459. [Google Scholar] [CrossRef]
  10. Bosarge, P.L.; Raff, L.A.; McGwin, G., Jr.; Carroll, S.L.; Bellot, S.C.; Diaz-Guzman, E.; Kerby, J.D. Early initiation of extracorporeal membrane oxygenation improves survival in adult trauma patients with severe adult respiratory distress syndrome. J. Trauma Acute Care Surg. 2016, 81, 236–243. [Google Scholar] [CrossRef]
  11. Combes, A.; Leprince, P.; Luyt, C.E.; Bonnet, N.; Trouillet, J.L.; Léger, P.; Pavie, A.; Chastre, J. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit. Care Med. 2008, 36, 1404–1411. [Google Scholar] [CrossRef] [PubMed]
  12. Massetti, M.; Tasle, M.; Le Page, O.; Deredec, R.; Babatasi, G.; Buklas, D.; Thuaudet, S.; Charbonneau, P.; Hamon, M.; Grollier, G.; et al. Back from irreversibility: Extracorporeal life support for prolonged cardiac arrest. Ann. Thorac. Surg. 2005, 79, 178–183. [Google Scholar] [CrossRef] [PubMed]
  13. Shin, T.G.; Choi, J.H.; Jo, I.J.; Sim, M.S.; Song, H.G.; Jeong, Y.K.; Song, Y.B.; Hahn, J.Y.; Choi, S.H.; Gwon, H.C.; et al. Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: A comparison with conventional cardiopulmonary resuscitation. Crit. Care Med. 2011, 39, 1–7. [Google Scholar] [CrossRef] [PubMed]
  14. Bednarczyk, J.M.; White, C.W.; Ducas, R.A.; Golian, M.; Nepomuceno, R.; Hiebert, B.; Bueddefeld, D.; Manji, R.A.; Singal, R.K.; Hussain, F.; et al. Resuscitative extracorporeal membrane oxygenation for in hospital cardiac arrest: A Canadian observational experience. Resuscitation 2014, 85, 1713–1719. [Google Scholar] [CrossRef] [PubMed]
  15. Pagani, F.D.; Aaronson, K.D.; Swaniker, F.; Bartlett, R.H. The use of extracorporeal life support in adult patients with primary cardiac failure as a bridge to implantable left ventricular assist device. Ann. Thorac. Surg. 2001, 71 (Suppl. 3), S77–S81. [Google Scholar] [CrossRef]
  16. Kagawa, E.; Dote, K.; Kato, M.; Sasaki, S.; Nakano, Y.; Kajikawa, M.; Higashi, A.; Itakura, K.; Sera, A.; Inoue, I.; et al. Should we emergently revascularize occluded coronaries for cardiac arrest?: Rapid-response extracorporeal membrane oxygenation and intra-arrest percutaneous coronary intervention. Circulation 2012, 126, 1605–1613. [Google Scholar] [CrossRef]
  17. Zangrillo, A.; Landoni, G.; Biondi-Zoccai, G.; Greco, M.; Greco, T.; Frati, G.; Patroniti, N.; Antonelli, M.; Pesenti, A.; Pappalardo, F. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit. Care Resusc. 2013, 15, 172–178. [Google Scholar]
  18. Ostermann, M.; Connor, M.; Jr Kashani, K. Continuous renal replacement therapy during extracorporeal membrane oxygenation: Why, when and how? Curr. Opin. Crit. Care 2018, 24, 493–503. [Google Scholar] [CrossRef]
  19. Kagawa, E.; Inoue, I.; Kawagoe, T.; Ishihara, M.; Shimatani, Y.; Kurisu, S.; Nakama, Y.; Dai, K.; Takayuki, O.; Ikenaga, H.; et al. Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest patients treated with cardiopulmonary resuscitation using extracorporeal life support. Resuscitation 2010, 81, 968–973. [Google Scholar] [CrossRef]
  20. Hei, F.; Lou, S.; Li, J.; Yu, K.; Liu, J.; Feng, Z.; Zhao, J.; Hu, S.; Xu, J.; Chang, Q.; et al. Five-year results of 121 consecutive patients treated with extracorporeal membrane oxygenation at Fu Wai Hospital. Artif. Organs 2011, 35, 572–578. [Google Scholar] [CrossRef]
  21. Tsai, T.Y.; Tsai, F.C.; Chang, C.H.; Jenq, C.C.; Hsu, H.H.; Chang, M.Y.; Tian, Y.C.; Hung, C.C.; Fang, J.T.; Yang, C.W.; et al. Prognosis of patients on extracorporeal membrane oxygenation plus continuous arteriovenous hemofiltration. Chang. Gung Med. J. 2011, 34, 636–643. [Google Scholar] [PubMed]
  22. Belle, L.; Mangin, L.; Bonnet, H.; Fol, S.; Santre, C.; Delavenat, L.; Savary, D.; Bougon, D.; Vialle, E.; Dompnier, A.; et al. Emergency extracorporeal membrane oxygenation in a hospital without on-site cardiac surgical facilities. EuroIntervention 2012, 8, 375–382. [Google Scholar] [CrossRef] [PubMed]
  23. Slottosch, I.; Liakopoulos, O.; Kuhn, E.; Deppe, A.C.; Scherner, M.; Madershahian, N.; Choi, Y.H.; Wahlers, T. Outcomes after peripheral extracorporeal membrane oxygenation therapy for postcardiotomy cardiogenic shock: A single-center experience. J. Surg. Res. 2013, 181, e47–e55. [Google Scholar] [CrossRef] [PubMed]
  24. Seco, M.; Forrest, P.; Jackson, S.A.; Martinez, G.; Andvik, S.; Bannon, P.G.; Ng, M.; Fraser, J.F.; Wilson, M.K.; Vallely, M.P. Extracorporeal membrane oxygenation for very high-risk transcatheter aortic valve implantation. Heart Lung Circ. 2014, 23, 957–962. [Google Scholar] [CrossRef] [PubMed]
  25. Saxena, P.; Neal, J.; Joyce, L.D.; Greason, K.L.; Schaff, H.V.; Guru, P.; Shi, W.Y.; Burkhart, H.; Li, Z.; Oliver, W.C.; et al. Extracorporeal Membrane Oxygenation Support in Postcardiotomy Elderly Patients: The Mayo Clinic Experience. Ann. Thorac. Surg. 2015, 99, 2053–2060. [Google Scholar] [CrossRef] [PubMed]
  26. Thajudeen, B.; Kamel, M.; Arumugam, C.; Ali, S.A.; John, S.G.; Meister, E.E.; Mosier, J.M.; Raz, Y.; Madhrira, M.; Thompson, J.; et al. Outcome of patients on combined extracorporeal membrane oxygenation and continuous renal replacement therapy: A retrospective study. Int. J. Artif. Organs 2015, 38, 133–137. [Google Scholar] [CrossRef] [PubMed]
  27. Lyu, L.; Long, C.; Hei, F.; Ji, B.; Liu, J.; Yu, K.; Chen, L.; Yao, J.; Hu, Q.; Hu, J.; et al. Plasma Free Hemoglobin Is a Predictor of Acute Renal Failure During Adult Venous-Arterial Extracorporeal Membrane Oxygenation Support. J. Cardiothorac. Vasc. Anesth. 2016, 30, 891–895. [Google Scholar] [CrossRef]
  28. Martucci, G.; Panarello, G.; Occhipinti, G. Anticoagulation and Transfusions Management in Veno-Venous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: Assessment of Factors Associated With Transfusion Requirements and Mortality. J. Intensive Care Med. 2017, 34, 630–639. [Google Scholar] [CrossRef]
  29. Yap, H.J.; Chen, Y.C.; Fang, J.T.; Huang, C.C. Combination of continuous renal replacement therapies (CRRT) and extracorporeal membrane oxygenation (ECMO) for advanced cardiac patients. Ren. Fail. 2003, 25, 183–193. [Google Scholar] [CrossRef]
  30. Lin, C.Y.; Chen, Y.C.; Tsai, F.C.; Tian, Y.C.; Jenq, C.C.; Fang, J.T.; Yang, C.W. RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation. Nephrol. Dial. Transplant. 2006, 21, 2867–2873. [Google Scholar] [CrossRef] [Green Version]
  31. Tsai, C.W.; Lin, Y.F.; Wu, V.C.; Chu, T.S.; Chen, Y.M.; Hu, F.C.; Wu, K.D.; Ko, W.J. SAPS 3 at dialysis commencement is predictive of hospital mortality in patients supported by extracorporeal membrane oxygenation and acute dialysis. Eur. J. Cardiothorac. Surg. 2008, 34, 1158–1164. [Google Scholar] [CrossRef]
  32. Bakhtiary, F.; Keller, H.; Dogan, S.; Dzemali, O.; Oezaslan, F.; Meininger, D.; Ackermann, H.; Zwissler, B.; Kleine, P.; Moritz, A. Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: Clinical experiences in 45 adult patients. J. Thorac. Cardiovasc. Surg. 2008, 135, 382–388. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  33. Luo, X.J.; Wang, W.; Hu, S.S.; Sun, H.S.; Gao, H.W.; Long, C.; Song, Y.H.; Xu, J.P. Extracorporeal membrane oxygenation for treatment of cardiac failure in adult patients. Interact. Cardiovasc. Thorac. Surg. 2009, 9, 296–300. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  34. Brogan, T.V.; Thiagarajan, R.R.; Rycus, P.T.; Bartlett, R.H.; Bratton, S.L. Extracorporeal membrane oxygenation in adults with severe respiratory failure: A multi-center database. Intensive Care Med. 2009, 35, 2105–2114. [Google Scholar] [CrossRef]
  35. Wang, J.; Han, J.; Jia, Y.; Zeng, W.; Shi, J.; Hou, X.; Meng, X. Early and intermediate results of rescue extracorporeal membrane oxygenation in adult cardiogenic shock. Ann. Thorac. Surg. 2009, 88, 1897–1903. [Google Scholar] [CrossRef] [PubMed]
  36. Yan, X.; Jia, S.; Meng, X.; Dong, P.; Jia, M.; Wan, J.; Hou, X. Acute kidney injury in adult postcardiotomy patients with extracorporeal membrane oxygenation: Evaluation of the RIFLE classification and the Acute Kidney Injury Network criteria. Eur. J. Cardiothorac. Surg. 2010, 37, 334–338. [Google Scholar] [CrossRef]
  37. Elsharkawy, H.A.; Li, L.; Esa, W.A.; Sessler, D.I.; Bashour, C.A. Outcome in patients who require venoarterial extracorporeal membrane oxygenation support after cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2010, 24, 946–951. [Google Scholar] [CrossRef]
  38. Hsu, P.S.; Chen, J.L.; Hong, G.J.; Tsai, Y.T.; Lin, C.Y.; Lee, C.Y.; Chen, Y.G.; Tsai, C.S. Extracorporeal membrane oxygenation for refractory cardiogenic shock after cardiac surgery: Predictors of early mortality and outcome from 51 adult patients. Eur. J. Cardiothorac. Surg. 2010, 37, 328–333. [Google Scholar] [CrossRef]
  39. Lan, C.; Tsai, P.R.; Chen, Y.S.; Ko, W.J. Prognostic factors for adult patients receiving extracorporeal membrane oxygenation as mechanical circulatory support—A 14-year experience at a medical center. Artif. Organs 2010, 34, E59–E64. [Google Scholar] [CrossRef]
  40. Rastan, A.J.; Dege, A.; Mohr, M.; Doll, N.; Falk, V.; Walther, T.; Mohr, F.W. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J. Thorac. Cardiovasc. Surg. 2010, 139, 302–311. [Google Scholar] [CrossRef]
  41. Wu, V.C.; Tsai, H.B.; Yeh, Y.C.; Huang, T.M.; Lin, Y.F.; Chou, N.K.; Chen, Y.S.; Han, Y.Y.; Chou, A.; Lin, Y.H.; et al. Patients supported by extracorporeal membrane oxygenation and acute dialysis: Acute physiology and chronic health evaluation score in predicting hospital mortality. Artif. Organs 2010, 34, 828–835. [Google Scholar] [CrossRef] [PubMed]
  42. Chen, Y.C.; Tsai, F.C.; Chang, C.H.; Lin, C.Y.; Jenq, C.C.; Juan, K.C.; Hsu, H.H.; Chang, M.Y.; Tian, Y.C.; Hung, C.C.; et al. Prognosis of patients on extracorporeal membrane oxygenation: The impact of acute kidney injury on mortality. Ann. Thorac. Surg. 2011, 91, 137–142. [Google Scholar] [CrossRef] [PubMed]
  43. Bermudez, C.A.; Rocha, R.V.; Toyoda, Y.; Zaldonis, D.; Sappington, P.L.; Mulukutla, S.; Marroquin, O.C.; Toma, C.; Bhama, J.K.; Kormos, R.L. Extracorporeal membrane oxygenation for advanced refractory shock in acute and chronic cardiomyopathy. Ann. Thorac. Surg. 2011, 92, 2125–2131. [Google Scholar] [CrossRef] [PubMed]
  44. Chang, W.W.; Tsai, F.C.; Tsai, T.Y.; Chang, C.H.; Jenq, C.C.; Chang, M.Y.; Tian, Y.C.; Hung, C.C.; Fang, J.T.; Yang, C.W.; et al. Predictors of mortality in patients successfully weaned from extracorporeal membrane oxygenation. PLoS ONE 2012, 7, e42687. [Google Scholar] [CrossRef] [PubMed]
  45. Kim, T.H.; Lim, C.; Park, I.; Kim, D.J.; Jung, Y.; Park, K.H. Prognosis in the patients with prolonged extracorporeal membrane oxygenation. Korea J. Thorac. Cardiovasc. Surg. 2012, 45, 236–241. [Google Scholar] [CrossRef] [PubMed]
  46. Lee, S.H.; Chung, C.H.; Won Lee, J.; Ho Jung, S.; Choo, S.J. Factors predicting early- and long-term survival in patients undergoing extracorporeal membrane oxygenation (ECMO). J. Card. Surg. 2012, 27, 255–263. [Google Scholar] [CrossRef] [PubMed]
  47. Loforte, A.; Montalto, A.; Ranocchi, F.; Della Monica, P.L.; Casali, G.; Lappa, A.; Menichetti, A.; Contento, C.; Musumeci, F. Peripheral extracorporeal membrane oxygenation system as salvage treatment of patients with refractory cardiogenic shock: Preliminary outcome evaluation. Artif. Organs 2012, 36, E53–E61. [Google Scholar] [CrossRef] [PubMed]
  48. Wu, M.Y.; Lee, M.Y.; Lin, C.C.; Chang, Y.S.; Tsai, F.C.; Lin, P.J. Resuscitation of non-postcardiotomy cardiogenic shock or cardiac arrest with extracorporeal life support: The role of bridging to intervention. Resuscitation 2012, 83, 976–981. [Google Scholar] [CrossRef]
  49. Aubron, C.; Cheng, A.C.; Pilcher, D.; Leong, T.; Magrin, G.; Cooper, D.J.; Scheinkestel, C.; Pellegrino, V. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: A 5-year cohort study. Crit. Care 2013, 17, R73. [Google Scholar] [CrossRef]
  50. Kielstein, J.T.; Heiden, A.M.; Beutel, G.; Gottlieb, J.; Wiesner, O.; Hafer, C.; Hadem, J.; Reising, A.; Haverich, A.; Kühn, C.; et al. Renal function and survival in 200 patients undergoing ECMO therapy. Nephrol. Dial. Transplant. 2013, 28, 86–90. [Google Scholar] [CrossRef]
  51. Wu, M.Y.; Tseng, Y.H.; Chang, Y.S.; Tsai, F.C.; Lin, P.J. Using extracorporeal membrane oxygenation to rescue acute myocardial infarction with cardiopulmonary collapse: The impact of early coronary revascularization. Resuscitation 2013, 84, 940–945. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  52. Lazzeri, C.; Bernardo, P.; Sori, A.; Innocenti, L.; Passantino, S.; Chiostri, M.; Gensini, G.F.; Valente, S. Renal replacement therapy in patients with refractory cardiac arrest undergoing extracorporeal membrane oxygenation. Resuscitation 2013, 84, e121–e122. [Google Scholar] [CrossRef] [PubMed]
  53. Unosawa, S.; Sezai, A.; Hata, M.; Nakata, K.; Yoshitake, I.; Wakui, S.; Kimura, H.; Takahashi, K.; Hata, H.; Shiono, M. Long-term outcomes of patients undergoing extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. Surg. Today 2013, 43, 264–270. [Google Scholar] [CrossRef] [PubMed]
  54. Xue, J.; Wang, L.; Chen, C.M.; Chen, J.Y.; Sun, Z.X. Acute kidney injury influences mortality in lung transplantation. Ren. Fail. 2014, 36, 541–545. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  55. Hsiao, C.C.; Chang, C.H.; Fan, P.C.; Ho, H.T.; Jenq, C.C.; Kao, K.C.; Chiu, L.C.; Lee, S.Y.; Hsu, H.H.; Tian, Y.C.; et al. Prognosis of patients with acute respiratory distress syndrome on extracorporeal membrane oxygenation: The impact of urine output on mortality. Ann. Thorac. Surg. 2014, 97, 1939–1944. [Google Scholar] [CrossRef] [PubMed]
  56. Lee, S.W.; Yu, M.Y.; Lee, H.; Ahn, S.Y.; Kim, S.; Chin, H.J.; Na, K.Y. Risk Factors for Acute Kidney Injury and In-Hospital Mortality in Patients Receiving Extracorporeal Membrane Oxygenation. PLoS ONE 2015, 10, e0140674. [Google Scholar] [CrossRef] [PubMed]
  57. Haneya, A.; Diez, C.; Philipp, A.; Bein, T.; Mueller, T.; Schmid, C.; Lubnow, M. Impact of Acute Kidney Injury on Outcome in Patients With Severe Acute Respiratory Failure Receiving Extracorporeal Membrane Oxygenation. Crit. Care Med. 2015, 43, 1898–1906. [Google Scholar] [CrossRef]
  58. Huang, L.; Li, T.; Xu, L.; Hu, X.M.; Duan, D.W.; Li, Z.B.; Gao, X.J.; Li, J.; Wu, P.; Liu, Y.W. Extracorporeal Membrane Oxygenation Outcomes in Acute Respiratory Distress Treatment: Case Study in a Chinese Referral Center. Med. Sci. Monit. 2017, 23, 741–750. [Google Scholar] [CrossRef] [Green Version]
  59. Antonucci, E.; Lamanna, I.; Fagnoul, D.; Vincent, J.L.; De Backer, D.; Silvio Taccone, F. The Impact of Renal Failure and Renal Replacement Therapy on Outcome During Extracorporeal Membrane Oxygenation Therapy. Artif. Organs 2016, 40, 746–754. [Google Scholar] [CrossRef]
  60. Tsai, T.Y.; Chien, H.; Tsai, F.C.; Pan, H.C.; Yang, H.Y.; Lee, S.Y.; Hsu, H.H.; Fang, J.T.; Yang, C.W.; Chen, Y.C. Comparison of, R.I.F.L.E.; AKIN, and KDIGO classifications for assessing prognosis of patients on extracorporeal membrane oxygenation. J. Formos. Med. Assoc. 2017, 116, 844–851. [Google Scholar] [CrossRef]
  61. Panholzer, B.; Meckelburg, K.; Huenges, K.; Hoffmann, G.; von der Brelie, M.; Haake, N.; Pilarczyk, K.; Cremer, J.; Haneya, A. Extracorporeal membrane oxygenation for acute respiratory distress syndrome in adults: An analysis of differences between survivors and non-survivors. Perfusion 2017, 32, 495–500. [Google Scholar] [CrossRef] [PubMed]
  62. Chong, S.Z.; Fang, C.Y.; Fang, H.Y.; Chen, H.C.; Chen, C.J.; Yang, C.H.; Hang, C.L.; Yip, H.K.; Wu, C.J.; Lee, W.C. Associations with the In-Hospital Survival Following Extracorporeal Membrane Oxygenation in Adult Acute Fulminant Myocarditis. J. Clin. Med. 2018, 7, 452. [Google Scholar] [CrossRef] [PubMed]
  63. Devasagayaraj, R.; Cavarocchi, N.C.; Hirose, H. Does acute kidney injury affect survival in adults with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation? Perfusion 2018, 33, 375–382. [Google Scholar] [CrossRef] [PubMed]
  64. Liao, X.; Cheng, Z.; Wang, L.; Li, B. Analysis of the risk factors of acute kidney injury in patients receiving extracorporeal membrane oxygenation. Clin. Nephrol. 2018, 90, 270–275. [Google Scholar] [CrossRef] [PubMed]
  65. Paek, J.H.; Park, S.; Lee, A.; Park, S.; Chin, H.J.; Na, K.Y.; Lee, H.; Park, J.T.; Kim, S. Timing for initiation of sequential continuous renal replacement therapy in patients on extracorporeal membrane oxygenation. Kidney Res. Clin. Pract. 2018, 37, 239–247. [Google Scholar] [CrossRef] [Green Version]
  66. He, P.; Zhang, S.; Hu, B.; Wu, W. Retrospective study on the effects of the prognosis of patients treated with extracorporeal membrane oxygenation combined with continuous renal replacement therapy. Ann. Transl. Med. 2018, 6, 455. [Google Scholar] [CrossRef] [PubMed]
  67. Zhang, H.; Wu, J.; Zou, D.; Xiao, X.; Yan, H.; Li, X.C.; Chen, W. Ablation of interferon regulatory factor 4 in T cells induces “memory” of transplant tolerance that is irreversible by immune checkpoint blockade. Am. J. Transplant. 2019, 19, 884–893. [Google Scholar] [CrossRef]
  68. Kilburn, D.J.; Shekar, K.; Fraser, J.F. The Complex Relationship of Extracorporeal Membrane Oxygenation and Acute Kidney Injury: Causation or Association? BioMed Res. Int. 2016, 2016, 1094296. [Google Scholar] [CrossRef]
  69. Cheng, R.; Hachamovitch, R.; Kittleson, M.; Patel, J.; Arabia, F.; Moriguchi, J.; Esmailian, F.; Azarbal, B. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1,866 adult patients. Ann. Thorac.Surg. 2014, 97, 610–616. [Google Scholar] [CrossRef]
  70. Lin, C.Y.; Tsai, F.C.; Tian, Y.C.; Jenq, C.C.; Chen, Y.C.; Fang, J.T.; Yang, C.W. Evaluation of outcome scoring systems for patients on extracorporeal membrane oxygenation. Ann. Thorac. Surg. 2007, 84, 1256–1262. [Google Scholar] [CrossRef]
  71. Moher, D.; Liberati, A.; Tetzlaff JAltman, D.G. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009, 6, e1000097. [Google Scholar] [CrossRef] [PubMed]
  72. Bellomo, R.; Ronco, C.; Kellum, J.A.; Mehta, R.L. Palevsky PAcute renal failure—Definition outcome measures animal, m.o.d.e.l.s., fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit. Care 2004, 8, R204–R212. [Google Scholar] [CrossRef] [PubMed]
  73. Mehta, R.L.; Kellum, J.A.; Shah, S.V.; Molitoris, B.A.; Ronco, C.; Warnock, D.G.; Levin, A. Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit. Care 2007, 11, R31. [Google Scholar] [CrossRef] [PubMed]
  74. Section 2: AKI Definition. Kidney Int. 2012, 2, 19–36. [CrossRef] [PubMed] [Green Version]
  75. DerSimonian, R.; Laird, N. Meta-analysis in clinical trials. Control. Clin. Trials 1986, 7, 177–188. [Google Scholar] [CrossRef]
  76. Higgins, J.P.; Thompson, S.G.; Deeks, J.J.; Altman, D.G. Measuring inconsistency in meta-analyses. BMJ 2003, 327, 557–560. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  77. Easterbrook, P.J.; Gopalan, R.; Berlin, J.A.; Matthews, D.R. Publication bias in clinical research. Lancet 1991, 337, 867–872. [Google Scholar] [CrossRef]
  78. McDonald, C.I.; Fraser, J.F.; Coombes, J.S.; Fung, Y.L. Oxidative stress during extracorporeal circulation. Eur. J. Cardiothorac. Surg. 2014, 46, 937–943. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  79. Ikeda, M.; Prachasilchai, W.; Burne-Taney, M.J.; Rabb, H.; Yokota-Ikeda, N. Ischemic acute tubular necrosis models and drug discovery: A focus on cellular inflammation. Drug Discov. Today 2006, 11, 364–370. [Google Scholar] [CrossRef] [PubMed]
  80. Yimin, H.; Wenkui, Y.; Jialiang, S.; Qiyi, C.; Juanhong, S.; Zhiliang, L.; Changsheng, H.; Ning, L.; Jieshou, L. Effects of continuous renal replacement therapy on renal inflammatory cytokines during extracorporeal membrane oxygenation in a porcine model. J. Cardiothorac. Surg. 2013, 8, 113. [Google Scholar] [CrossRef] [PubMed]
  81. McILwain, R.B.; Timpa, J.G.; Kurundkar, A.R.; Holt, D.W.; Kelly, D.R.; Hartman, Y.E.; Neel, M.L.; Karnatak, R.K.; Schelonka, R.L.; Anantharamaiah, G.M.; et al. Plasma concentrations of inflammatory cytokines rise rapidly during ECMO-related SIRS due to the release of preformed stores in the intestine. Lab. Investig. 2010, 90, 128–139. [Google Scholar] [CrossRef] [PubMed]
  82. Reed, R.C.; Rutledge, J.C. Laboratory and clinical predictors of thrombosis and hemorrhage in 29 pediatric extracorporeal membrane oxygenation nonsurvivors. Pediatr. Dev. Pathol. 2010, 13, 385–392. [Google Scholar] [CrossRef] [PubMed]
  83. Williams, D.C.; Turi, J.L.; Hornik, C.P.; Bonnadonna, D.K.; Williford, W.L.; Walczak, R.J.; Watt, K.M.; Cheifetz, I.M. Circuit oxygenator contributes to extracorporeal membrane oxygenation-induced hemolysis. ASAIO J. 2015, 61, 190–195. [Google Scholar] [CrossRef] [PubMed]
  84. Askenazi, D.J.; Selewski, D.T.; Paden, M.L.; Cooper, D.S.; Bridges, B.C.; Zappitelli, M.; Fleming, G.M. Renal replacement therapy in critically ill patients receiving extracorporeal membrane oxygenation. Clin. J. Am. Soc. Nephrol. 2012, 7, 1328–1336. [Google Scholar] [CrossRef] [PubMed]
  85. Lubnow, M.; Philipp, A.; Foltan, M.; Enger, T.B.; Lunz, D.; Bein, T.; Haneya, A.; Schmid, C.; Riegger, G.; Müller, T.; et al. Technical complications during veno-venous extracorporeal membrane oxygenation and their relevance predicting a system-exchange—Retrospective analysis of 265 cases. PLoS ONE 2014, 9, e112316. [Google Scholar] [CrossRef] [PubMed]
  86. Murphy, D.A.; Hockings, L.E.; Andrews, R.K.; Aubron, C.; Gardiner, E.E.; Pellegrino, V.A.; Davis, A.K. Extracorporeal membrane oxygenation-hemostatic complications. Transfus. Med. Rev. 2015, 29, 90–101. [Google Scholar] [CrossRef]
  87. Lehle, K.; Philipp, A.; Zeman, F.; Lunz, D.; Lubnow, M.; Wendel, H.P.; Göbölös, L.; Schmid, C.; Müller, T. Technical-Induced Hemolysis in Patients with Respiratory Failure Supported with Veno-Venous ECMO—Prevalence and Risk Factors. PLoS ONE 2015, 10, e0143527. [Google Scholar] [CrossRef] [PubMed]
  88. Adademir, T.; Ak, K.; Aljodi, M.; Elçi, M.E.; Arsan, S.; Isbir, S. The effects of pulsatile cardiopulmonary bypass on acute kidney injury. Int. J. Artif. Organs 2012, 35, 511–519. [Google Scholar] [CrossRef]
  89. Abu-Omar, Y.; Ratnatunga, C. Cardiopulmonary bypass and renal injury. Perfusion 2006, 21, 209–213. [Google Scholar] [CrossRef]
  90. Santana-Santos, E.; Marcusso, M.E.; Rodrigues, A.O.; Queiroz, F.G.; Oliveira, L.B.; Rodrigues, A.R.; Palomo, J.D. Strategies for prevention of acute kidney injury in cardiac surgery: An integrative review. Revista Brasileira Terpia Intensiva 2014, 26, 183–192. [Google Scholar] [CrossRef]
  91. Thongprayoon, C.; Kaewput, W.; Thamcharoen, N.; Bathini, T.; Watthanasuntorn, K.; Lertjitbanjong, P.; Sharma, K.; Salim, S.A.; Ungprasert, P.; Wijarnpreecha, K.; et al. Incidence and Impact of Acute Kidney Injury after Liver Transplantation: A Meta-Analysis. J. Clin. Med. 2019, 8, 372. [Google Scholar] [CrossRef] [PubMed]
  92. Thongprayoon, C.; Kaewput, W.; Thamcharoen, N.; Bathini, T.; Watthanasuntorn, K.; Salim, S.A.; Ungprasert, P.; Lertjitbanjong, P.; Aeddula, N.R.; Torres-Ortiz, A.; et al. Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. J. Clin. Med. 2019, 8, 66. [Google Scholar] [CrossRef] [PubMed]
  93. Thongprayoon, C.; Cheungpasitporn, W.; Mao, M.A.; Harrison, A.M.; Erickson, S.B. Elevated admission serum calcium phosphate product as an independent risk factor for acute kidney injury in hospitalized patients. Hosp. Pract. (1995) 2019, 47, 73–79. [Google Scholar] [CrossRef] [PubMed]
  94. Thongprayoon, C.; Cheungpasitporn, W.; Mao, M.A.; Sakhuja, A.; Kashani, K. U-shape association of serum albumin level and acute kidney injury risk in hospitalized patients. PLoS ONE 2018, 13, e0199153. [Google Scholar] [CrossRef] [PubMed]
  95. Thongprayoon, C.; Cheungpasitporn, W.; Mao, M.A.; Sakhuja, A.; Erickson, S.B. Admission calcium levels and risk of acute kidney injury in hospitalised patients. Int. J. Clin. Pract. 2018, 72, e13057. [Google Scholar] [CrossRef] [PubMed]
  96. Thongprayoon, C.; Cheungpasitporn, W.; Mao, M.A.; Sakhuja, A.; Erickson, S.B. Admission hyperphosphatemia increases the risk of acute kidney injury in hospitalized patients. J. Nephrol. 2018, 31, 241–247. [Google Scholar] [CrossRef] [PubMed]
  97. Razo-Vazquez, A.O.; Thornton, K. Extracorporeal Membrane Oxygenation-What the Nephrologist Needs to Know. Adv. Chronic Kidney Dis. 2016, 23, 146–151. [Google Scholar] [CrossRef]
  98. Pedersen, T.H.; Videm, V.; Svennevig, J.L.; Karlsen, H.; Østbakk, R.W.; Jensen, Ø.; Mollnes, T.E. Extracorporeal membrane oxygenation using a centrifugal pump and a servo regulator to prevent negative inlet pressure. Ann. Thorac. Surg. 1997, 63, 1333–1339. [Google Scholar] [CrossRef]
  99. Kress, D.C.; Cohen, D.J.; Swanson, D.K.; Hegge, J.O.; Young, J.W.; Watson, K.M.; Rasmussen, P.W.; Berkoff, H.A. Pump-induced hemolysis in a rabbit model of neonatal ECMO. ASAIO Trans. 1987, 33, 446–452. [Google Scholar]
  100. Lou, S.; MacLaren, G.; Best, D.; Delzoppo, C.; Butt, W. Hemolysis in pediatric patients receiving centrifugal-pump extracorporeal membrane oxygenation: Prevalence, risk factors, and outcomes. Crit. Care Med. 2014, 42, 1213–1220. [Google Scholar] [CrossRef]
  101. Toomasian, J.M.; Bartlett, R.H. Hemolysis and ECMO pumps in the 21st Century. Perfusion 2011, 26, 5–6. [Google Scholar] [CrossRef] [PubMed]
  102. Thongprayoon, C.; Cheungpasitporn, W.; Kittanamongkolchai, W.; Harrison, A.M.; Kashani, K. Prognostic Importance of Low Admission Serum Creatinine Concentration for Mortality in Hospitalized Patients. Am. J. Med. 2017, 130, 545–554. [Google Scholar] [CrossRef] [PubMed]
  103. Thongprayoon, C.; Cheungpasitporn, W.; Kashani, K. Serum creatinine level, a surrogate of muscle mass, predicts mortality in critically ill patients. J. Thorac. Dis. 2016, 8, E305–E311. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  104. Thongprayoon, C.; Cheungpasitporn, W.; Kittanamongkolchai, W.; Srivali, N.; Ungprasert, P.; Kashani, K. Optimum methodology for estimating baseline serum creatinine for the acute kidney injury classification. Nephrology (Carlton) 2015, 20, 881–886. [Google Scholar] [CrossRef] [PubMed]
  105. Vaidya, V.S.; Ramirez, V.; Ichimura, T.; Bobadilla, N.A.; Bonventre, J.V. Urinary kidney injury molecule-1: A sensitive quantitative biomarker for early detection of kidney tubular injury. Am. J. Physiol. Renal Physiol. 2006, 290, F517–F529. [Google Scholar] [CrossRef]
  106. Mishra, J.; Ma, Q.; Prada, A.; Mitsnefes, M.; Zahedi, K.; Yang, J.; Barasch, J.; Devarajan, P. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J. Am. Soc. Nephrol. 2003, 14, 2534–2543. [Google Scholar] [CrossRef]
  107. Hosohata, K.; Ando, H.; Fujimura, A. Urinary vanin-1 as a novel biomarker for early detection of drug-induced acute kidney injury. J. Pharmacol. Exp. Ther. 2012, 341, 656–662. [Google Scholar] [CrossRef]
  108. Kashani, K.; Cheungpasitporn, W.; Ronco, C. Biomarkers of acute kidney injury: The pathway from discovery to clinical adoption. Clin. Chem. Lab. Med. 2017, 55, 1074–1089. [Google Scholar] [CrossRef]
Jcm 08 00981 g001 550
Figure 1. The flowchart for the systematic review.
Figure 1. The flowchart for the systematic review.
Jcm 08 00981 g001
Jcm 08 00981 g002 550
Figure 2. Forest plots of the included studies assessing (A) incidence rates of AKI while on ECMO and (B) incidence rate of severe AKI requiring RRT while on ECMO. A diamond data marker depicts the overall rate from each included study (square data marker) and 95%CI.
Figure 2. Forest plots of the included studies assessing (A) incidence rates of AKI while on ECMO and (B) incidence rate of severe AKI requiring RRT while on ECMO. A diamond data marker depicts the overall rate from each included study (square data marker) and 95%CI.
Jcm 08 00981 g002
Jcm 08 00981 g003 550
Figure 3. Meta-regression analyses showed that year of the study did not significantly affect (A) the incidence of AKI (p = 0.67) or (B) AKI requiring RRT (p = 0.83). The solid black line depicts the weighted regression line based on variance-weighted least squares. The inner and outer lines represent the 95%CI and prediction interval encompassing the regression line. The circles indicate log event rates in individual study.
Figure 3. Meta-regression analyses showed that year of the study did not significantly affect (A) the incidence of AKI (p = 0.67) or (B) AKI requiring RRT (p = 0.83). The solid black line depicts the weighted regression line based on variance-weighted least squares. The inner and outer lines represent the 95%CI and prediction interval encompassing the regression line. The circles indicate log event rates in individual study.
Jcm 08 00981 g003
Jcm 08 00981 g004 550
Figure 4. Forest plots of the included studies assessing (A) mortality rate of patients with AKI while on ECMO and (B) mortality rate of patients with severe AKI requiring RRT while on ECMO. A diamond data label serves as the overall rate from each study (square data marker) and 95%CI.
Figure 4. Forest plots of the included studies assessing (A) mortality rate of patients with AKI while on ECMO and (B) mortality rate of patients with severe AKI requiring RRT while on ECMO. A diamond data label serves as the overall rate from each study (square data marker) and 95%CI.
Jcm 08 00981 g004
Jcm 08 00981 g005 550
Figure 5. Forest plots of the included studies assessing (A) hospital mortality among patients receiving ECMO with AKI on RRT and (B) hospital mortality among patients receiving ECMO with AKI on RRT limited to studies with confounder-adjusted analysis. A diamond data label serves as the overall rate from each included study (square data marker) and 95%CI.
Figure 5. Forest plots of the included studies assessing (A) hospital mortality among patients receiving ECMO with AKI on RRT and (B) hospital mortality among patients receiving ECMO with AKI on RRT limited to studies with confounder-adjusted analysis. A diamond data label serves as the overall rate from each included study (square data marker) and 95%CI.
Jcm 08 00981 g005
Jcm 08 00981 g006 550
Figure 6. Meta-regression analyses showed that year of the study did not significantly affect hospital mortality among patients receiving ECMO with AKI requiring RRT (p = 0.86). The solid black line depicts the weighted regression line based on variance-weighted least squares. The inner and outer lines represent the 95%CI and prediction interval encompassing the regression line. The circles indicate log event rates in an individual study.
Figure 6. Meta-regression analyses showed that year of the study did not significantly affect hospital mortality among patients receiving ECMO with AKI requiring RRT (p = 0.86). The solid black line depicts the weighted regression line based on variance-weighted least squares. The inner and outer lines represent the 95%CI and prediction interval encompassing the regression line. The circles indicate log event rates in an individual study.
Jcm 08 00981 g006
Jcm 08 00981 g007 550
Figure 7. Funnel plot demonstrated no publication bias in analyses evaluating (A) incidence of AKI in patients requiring ECMO and (B) severe AKI requiring RRT.
Figure 7. Funnel plot demonstrated no publication bias in analyses evaluating (A) incidence of AKI in patients requiring ECMO and (B) severe AKI requiring RRT.
Jcm 08 00981 g007
Table
Table 1. Main characteristic of studies included in this meta-analysis of AKI incidence and mortality among patients requiring ECMO [7,15,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67].
Table 1. Main characteristic of studies included in this meta-analysis of AKI incidence and mortality among patients requiring ECMO [7,15,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67].
StudyYearCountryPatientsNumberAKI DefinitionAKI IncidenceMortality
Pagani et al. [15]2001USAECMO for cardiogenic shock or arrest33RRTRRT
10/33 (30.3%)		Hospital mortality
9/10 (90%)
Yap et al. [29]2003TaiwanECMO for cardiogenic shock10RRTRRT
5/10 (50%)		Mortality
5/5 (100%)
Lin et al. [30]2006TaiwanECMO46AKI; RIFLE criteriaAKI
36/46 (78.3%)
CRRT
16/46 (34.8%)		AKI: Hospital mortality
28/36 (78%)
CRRT: Hospital mortality
16/16 (100%)
Tsai et al. [31]2008TaiwanECMO288CRRTCRRT
104/288 (36.1%)		Hospital mortality
79/104 (76%)
Bakhtiary et al. [32]2008GermanyVA-ECMO for refractory cardiogenic shock45CRRTCRRT
39/45 (86.7%)		N/A
Luo et al. [33]2009ChinaVA-ECMO in severe heart failure45CRRTCRRT
12/45 (26.6%)		Hospital mortality
7/9 (78%)
Brogan et al. [34]2009USAECMO in severe respiratory failure1473RRTRRT
648/1473 (44%)		Hospital mortality
RRT
390/648 (60%)
Wang et al. [35] 2009ChinaVA ECMO for refractory cardiogenic shock after cardiac surgery62CRRTCRRT
23/62 (37.0%)		N/A
Yan et al. [36]2010ChinaECMO after cardiac surgery67AKI; RIFLE and AKIN criteriaRIFLE AKI
54/67 (80.6%)
AKIN AKI
57/67 (85.1%)
RRT
30/67 (44.8%)		Hospital mortality
RIFLE AKI
32/54 (59%)
AKIN AKI
33/57 (58%)
RRT
22/30 (73%)
Elsharkawy et al. [37]2010USAVA-ECMO after cardiac surgery233RRTRRT
101/233 (43.3%)		Hospital mortality
79/101 (78%)
Hsu et al. [38]2010TaiwanVA-ECMO for cardiogenic shock after cardiac surgery51CRRTCRRT
38/51 (74.5%)		N/A
Lan et al. [39]2010TaiwanECMO607RRTRRT
301/607 (49.6%)		Hospital mortality
259/301 (86%)
Rastan et al. [40]2010GermanyVA-ECMO for cardiogenic shock after cardiac surgery517RRTRRT
336/517 (65.0%)		N/A
Wu et al. [41]2010TaiwanECMO 346RRTRRT
187/346 (54%)		RRT
72/102 (71%)
Chen et al. [42]2011TaiwanECMO102AKI; AKIN criteriaAKI
62/102 (60.8%)
CRRT
26/102 (25.5%)		Hospital mortality
AKI
51/62 (82%)
CRRT
22/26 (85%)
Bermudez et al. [43]2011USAECMO for refractory cardiogenic shock; VA (88%)42RRTRRT
17/42 (40.5%)		N/A
Chang et al. [44]2012TaiwanSuccessfully weaned from ECMO 113AKI; AKIN criteria at 48 h post-ECMO removalAKI
51/113 (45.1%)		Hospital mortality
AKI
23/51 (45%)
Kim et al. [45]2012Korea ECMO; VA-ECMO (85%), VV-ECMO (15%)26AKI; AKIN criteriaAKI
10/26 (38.5%)		N/A
Lee et al. [46]2012KoreaECMO; VA-ECMO (74%), VV-ECMO (26%)185CRRTCRRT
76/185 (41.1%)		N/A
Loforte et al. [47]2012ItalyVA-ECMO73CRRTCRRT
38/73 (52.1%)		N/A
Wu et al. [48]2012TaiwanECMO for non-post cardiotomy cardiogenic shock or cardiac arrest60RRTRRT
19/60 (31.7%)		Hospital mortality
13/19 (68%)
Aubron et al. [49]2013AustraliaECMO; VA-ECMO (67%), VV-ECMO (33%)158RRTVA-ECMO
RRT
61/105 (58.1%)
VV-ECMO
RRT
27/53 (50.9%)		Hospital mortality
VA-ECMO
RRT
27/61 (44%)
VV-ECMO
RRT
13/27 (48%)
Kielstein et al. [50]
2013GermanyECMO; VA-ECMO (45%), VV-ECMO (55%)200RRTRRT
117/200 (58.5%)
RRT after ECMO
92/175 (52.6%)		90-day mortality
97/117 (83%)
Wu et al. [51]2013TaiwanECMO for acute myocardial infarction-induced cardiac arrest 35RRTRRT
16/35 (45.7%)		Hospital mortality
14/16 (88%)
Lazzeri et al. [52]2013ItalyECMO for refractory cardiac arrest 25RRTRRT
16/24 (66.7%)		Mortality
9/16 (56%)
Unosawa et al. [53]2013JapanVA-ECMO for refractory cardiogenic shock after cardiac surgery47RRTRRT
15/47 (31.9%)		Mortality on ECMO
7/15 (46.7%)
Xue et al. [54]2014ChinaECMO in lung transplantation45AKI; AKIN criteriaAKI
17/45 (37.8%)		N/A
Schmidt et al. [7]2014AustraliaECMO for refractory cardiogenic shock or acute respiratory failure172AKI; RIFLE criteria
AKI at ECMO day 1
98/172 (57.0%)
CRRT during ECMO
103/172 (59.9%)		90-day mortality
CRRT
34/103 (33%)
Hsiao et al. [55]2014TaiwanECMO for ARDS81CRRTCRRT
33/81 (40.7%)		Hospital mortality
CRRT
22/33 (67%)
Lee et al. [56]2015KoreaECMO; VA-ECMO (71%), VV-ECMO (29%)322AKI; KDIGO criteriaAKI
265/322 (82.3%)		Hospital mortality
151/265 (57%)
Haneya [57]2015GermanyVV-ECMO for ARDS262AKI; KDIGO criteriaAKI
109/262 (41.6%)
RRT during ECMO
52/262 (19.8%)		Mortality
AKI
56/109 (51%)
RRT during ECMO
23/52 (44%)
Huang et al. [58]2016ChinaECMO for acute respiratory distress syndrome; VA-ECMO (17%), VV-ECMO (83%)23AKI; AKIN criteria AKI
13/23 (56.5%)		Mortality
9/13 (69%)
Antonucci et al. [59]2016BelgiumECMO; VA-ECMO (59%), VV-ECMO (41%)135AKI; AKIN criteriaAKI
95/135 (70.4%)
CRRT
63/135 (46.7%)		ICU mortality
AKI
55/95 (58%)
CRRT
38/63 (60%)
Tsai et al. [60]2017TaiwanECMO167AKI; RIFLE, AKIN and KDIGO on ECMO day 1RIFLE AKI
126/167 (75.4%)
AKIN AKI
141/167 (84.4%)
KDIGO AKI
142/167 (85.0%)		Hospital mortality
RIFLE AKI
85/126 (67%)
AKIN AKI
90/126 (71%)
RIFLE AKI
90/126 (71%)
Panholzer et al. [61]2017GermanyVV-ECMO for ARDS46RRTRRT
31/46 (67.4%)		Mortality
RRT
23/31 (74%)
Chong et al. [62]2018TaiwanVA-ECMO for acute fulminant myocarditis and cardiogenic shock35AKI; not specifiedAKI
26/35 (74.3%)
RRT
15/35 (42.9%)		Hospital mortality
AKI
14/26 (54%)
RRT
11/15 (73%)
Devasagayaraj et al. [63]2018USAVV-ECMO for ARDS54CRRTCRRT
16/54 (29.6%)		Hospital mortality
9/16 (56%)
Liao et al. [64]2018 ChinaECMO; VA-ECMO (93%), VV-ECMO (7%)170AKI; KDIGO criteriaAKI
91/170 (53.5%)		N/A
Paek et al. [65]2018KoreaECMO538CRRTCRRT
296/838 (35.3%)		30-day mortality
195/296 (66%)
He et al. [66]2018ChinaECMO92CRRTCRRT
32/92 (34.8%)		Hospital mortality
19/32 (59%)
Chen et al. [67]2019TaiwanECMO3251RRTRRT
1759/3251 (54.1%)		Hospital mortality
1298/1759 (74%)
Abbreviations: AKI, acute kidney injury; ARDS, acute respiratory distress syndrome; AKIN, Acute Kidney Injury Network; CRRT, continuous renal replacement therapy; ECMO, Extracorporeal membrane oxygenation; ICU, intensive care unit; KDIGO, Kidney Disease Improving Global Outcomes; N/A, not available; RIFLE, Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease; RRT, Renal replacement therapy; USA, United States of America; VA-ECMO, venoarterial extracorporeal membrane oxygenation; VV-ECMO, venovenous extracorporeal membrane oxygenation.
Table
Table 2. Characteristics of studies included in this meta-analysis of AKI associated mortality risk among patients requiring ECMO.
Table 2. Characteristics of studies included in this meta-analysis of AKI associated mortality risk among patients requiring ECMO.
Study.YearNumberOutcomesConfounder Adjustment
Pagani et al. [15]200133Hospital mortality
8.25 (0.89–76.12)		None
Lin et al. [30]200646Hospital mortality
AKI: 14.0 (2.46–79.55)
CRRT: 16/16 vs. 14/30		None
Luo et al. [33]200945Hospital mortality
CRRT: 7.0 (1.26–38.99)		None
Brogan et al. [34]20091473Hospital mortality
Renal insufficiency/failure: 2.13 (1.69–2.72)
RRT: 2.13 (1.73–2.63)		Age, duration of mechanical ventilation, weight, pre-ECMO pH, race, diagnosis, ECMO mode, post-ECMO complication
Elsharkawy et al. [37]2010233Hospital mortality
RRT: 3.18 (1.77–5.70)		None
Yan et al. [36]201067Hospital mortality
RIFLE AKI: 8.0 (1.61–39.68)
AKIN AKI: 12.38 (1.47–104.33)
CRRT: 5.73 (1.98–16.58)		None
Lan et al. [39]2010607Hospital mortality
RRT: 6.49 (4.12–10.23)		Age, stroke, pre-ECMO infection, hypoglycemia, alkalosis
Chen et al. [67]2011102Hospital mortality
AKI: 4.32 (1.65–11.30)
CRRT: 5.80 (1.82–18.43)		Age, GCS
Chang et al. [44]2012113Hospital mortality
AKI: 2.1 (1.48–3.00)		None
Wu et al. [48]201260Hospital mortality
RRT: 3.76 (1.18–11.95)		None
Kielstein et al. [50]201320090-day mortality
RRT: 5.47(2.87–10.44)		None
Aubron et al. [49]2013158VA ECMO
RRT: 2.12 (0.92–4.88)
VV ECMO
RRT: 2.52 (0.80–7.95)		None
Wu et al. [51]201335Hospital mortality
RRT: 12 (2.08–69.09)		None
Slottosch et al. [23]20137730-day mortality
Renal failure: 2.20 (0.78–6.12)		None
Unosawa et al. [53]201347Mortality during ECMO
RRT: 1.67 (0.48–5.83)		None
Lazzeri et al. [52]201325Mortality
RRT: 2.14 (0.38–12.20)		None
Hsiao et al. [55]201481Hospital mortality
CRRT: 2.17 (0.87–5.45)		None
Schmidt et al. [7]2014172Hospital mortality
CRRT at ECMO day 1–3: 4.1 (1.71–9.82)
90-day mortality
CRRT at ECMO day 1–3: 3.17 (1.32–7.61)		APACHE, fluid balance, major bleeding, propensity score
Lee et al. [56]2015322Hospital mortality
AKI: 3.71 (1.96–7.02)		None
Haneya et al. [57]2015262Mortality
AKI: 2.18 (1.31–3.61)
RRT during ECMO: 1.72 (0.53–5.59)		Age, SOFA score, minute volume, pH, lactate, RRT prior to ECMO, RBC, and FFP transfusion
Huang et al. [58]201623Mortality
AKI: 20.25 (1.88–218.39)		None
Lyu et al. [27]201684Mortality
ARF: 23.90 (7.00–81.60)		None
Antonucci et al. [59]2016135ICU mortality
AKI: 1.86 (0.88–3.93)
CRRT: 1.70 (0.85–3.37)		None
Tsai et al. [60]2017167Hospital mortality
RIFLE AKI: 8.55 (3.63–20.16)
AKIN AKI: 13.53 (3.87–47.28)
KDIGO AKI: 12.69 (3.62–44.46)		None
Panholzer et al. [61]201746Mortality
RRT: 40.25 (4.54–356.93)		None
Martucci et al. [28]201782Mortality on ECMO
AKI stage 3: 4.55 (1.37–15.17)		None
Chong et al. [62]201835Hospital mortality
AKI: 9.33 (1.02–85.70)
RRT: 11.0 (2.26–53.64)		None
Devasagayaraj et al. [63]201854Hospital mortality
RRT: 5.69 (1.58–20.56)		None
Chen et al. [67]20193,251Hospital mortality
RRT: 3.92 (3.36–4.57)		Age, sex, ECMO indication, comorbid conditions, hospital level, study year
Abbreviations: AKI, acute kidney injury; ARDS, acute respiratory distress syndrome; AKIN, Acute Kidney Injury Network; APACHE, Acute Physiology and Chronic Health Evaluation; CRRT, continuous renal replacement therapy; ECMO, Extracorporeal membrane oxygenation; FFP, fresh frozen plasma; GCS, Glasgow Coma Scale/Score; ICU, intensive care unit; KDIGO, Kidney Disease Improving Global Outcomes; N/A, not available; RIFLE, Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease; RBC, red blood cells; RRT, Renal replacement therapy; pH, potential hydrogen; SOFA, Sequential Organ Failure Assessment; VA-ECMO, venoarterial extracorporeal membrane oxygenation; VV-ECMO, venovenous extracorporeal membrane oxygenation.

Share and Cite

MDPI and ACS Style

Thongprayoon, C.; Cheungpasitporn, W.; Lertjitbanjong, P.; Aeddula, N.R.; Bathini, T.; Watthanasuntorn, K.; Srivali, N.; Mao, M.A.; Kashani, K. Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis. J. Clin. Med. 2019, 8, 981. https://doi.org/10.3390/jcm8070981

AMA Style

Thongprayoon C, Cheungpasitporn W, Lertjitbanjong P, Aeddula NR, Bathini T, Watthanasuntorn K, Srivali N, Mao MA, Kashani K. Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis. Journal of Clinical Medicine. 2019; 8(7):981. https://doi.org/10.3390/jcm8070981

Chicago/Turabian Style

Thongprayoon, Charat, Wisit Cheungpasitporn, Ploypin Lertjitbanjong, Narothama Reddy Aeddula, Tarun Bathini, Kanramon Watthanasuntorn, Narat Srivali, Michael A. Mao, and Kianoush Kashani. 2019. "Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis" Journal of Clinical Medicine 8, no. 7: 981. https://doi.org/10.3390/jcm8070981

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop