TỔN THƯƠNG THẬN CẤP Ở BỆNH NHÂN ĐƯỢC HỖ TRỢ VA-ECMO: NGHIÊN CỨU HỒI CỨU

Abstract

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to support patients with refractory cardiogenic shock. Acute kidney injury (AKI) is a common complication in ECMO patients, particularly in the VA-ECMO group, due to critical illness and hemodynamic instability. Objectives: This study aimed to evaluate the incidence, severity, and clinical outcomes of AKI in patients receiving VA-ECMO at a tertiary intensive care unit in Vietnam. Methods: We conducted a retrospective study of 73 patients who underwent VA-ECMO at the Center for Critical Care Medicine of Bach Mai Hospital between January 2022 and June 2023. AKI was diagnosed and staged according to KDIGO criteria. The need for renal replacement therapy (RRT) and its association with mortality was also analyzed. Results: AKI occurred in 76.7% of patients, with 32.1% developing AKI after ECMO initiation. Most patients with post-ECMO AKI had stage 3 AKI. Continuous renal replacement therapy was required in 75% of AKI cases. In-hospital mortality was significantly higher in patients with AKI (60.7%) compared to those without AKI (5.9%). AKI onset after ECMO, stage 3 AKI, and AKI requiring RRT were strongly associated with increased mortality. Conclusion: AKI is a frequent and severe complication in patients supported with VA-ECMO and is associated with high mortality, especially when RRT is required. Early recognition and management of AKI in ECMO patients may improve outcomes.