13: Challenging Prognostic Accuracy in ECPR: An Intriguing Case Study

Background: Kidneys alter urine flow and sodium excretion in response to acute changes in renal perfusion pressure – Pressure natriuresis. This is the central component that acts a feedback system for long term control of extra cellular fluid volume and blood pressure., Pressure natriuresis is a non-adaptive mechanism where increased blood pressure leads to osmotically driven diuresis. Case Report: We report the case of a 51-year-old, diabetic, hypertensive, post-Percutaneous Transluminal Coronary Angioplasty (PTCA) (2021) patient who presented in cardiogenic shock SCAI stage C, progressed to SCAI stage D, E, and had cardiac arrest during Percutaneous Coronary Intervention (PCI). High quality cardiopulmonary resuscitation (CPR) was quickly initiated and converted to ECPR with VA ECMO support being initiated within 30 minutes. Within an hour into ECMO, the patient had a urine output of 1500-2000 ml/hour, with a total volume exceeding 20 litres within 16-18 hours. With the background of CPR, we believed it was probably cranial diabetes insipidus and almost painted a grave prognosis to the family. However, the neurological examination and investigations were not in favor of a central pathology. Then thorough literature review enlightened us about the fact that the positioning of the arterial cannula in relation to the renal vasculature may lead to an increased Glomerular Filtration Rate (GFR) and increased urinary output (3). Performing certain interventions lead to resolution of the polyuria and motivated us to continue with ECMO support instead of withdrawing it based on misleading signs. Conclusion: We would like to highlight this rare scenario and an interesting solution to counter any undue withdrawal of supports.