This study seeks to evaluate the association between acute kidney injury (AKI), fluid overload (FO), and mortality in children supported with extracorporeal membrane oxygenation (ECMO) for refractory respiratory failure. This retrospective observational cohort study was performed at six tertiary care children’s hospital intensive care units, studying 424 patients < 18 years of age supported with ECMO for ≥ 24 hours for a respiratory indication from January 1, 2007, to December 31, 2011. In a multivariate analysis, FO level at ECMO initiation was not associated with hospital mortality, whereas peak FO level during ECMO was associated with hospital mortality. For every 10% increase in peak FO during ECMO, the odds of hospital mortality were approximately 1.2 times higher. Every 10% increase in peak FO during ECMO resulted in a significant relative change in the duration of ECMO hours by a factor of 1.08. For hospital survivors, every 10% increase in peak FO level during ECMO resulted in a significant relative change in the duration of mechanical ventilation hours by a factor of 1.13. In this patient population, AKI and FO are associated with increased mortality and should be considered targets for medical interventions including judicious fluid management, diuretic use, and renal replacement therapy.
From the *Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
†Department of Pediatrics & Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
‡Department of Pediatrics, University of Alabama Birmingham, Birmingham, Alabama
§Department of Pediatrics, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
¶Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
‖Department of Pediatrics, Emory University, Atlanta, Georgia
#Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
**Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
††Department of Pediatrics, Division of Nephrology, Toronto Hospital for Sick Children, Toronto, Ontario, Canada.
Submitted for consideration July 2018; accepted for publication in revised form March 2019.
Disclosure: The authors have no conflicts of interest to report.
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Correspondence: Palen Mallory, Department of Pediatrics, Duke University School of Medicine, Durham, NC. Email: email@example.com.