18: When Support Strains: Repercussions of ECMO; Breathing on Borrowed Time

Background: Extracorporeal membrane oxygenation is a lifesaving intervention for patients with potentially reversible severe cardiac or respiratory failure. Acute kidney injury is a frequent complication during extracorporeal support and is associated with increased morbidity, need for renal replacement therapy, and poor outcomes. This study aimed to evaluate the incidence, risk factors, and outcomes of acute kidney injury in patients receiving extracorporeal membrane oxygenation. Methods: This single centre prospective observational study was conducted between 2023 and 2025 and included 45 patients who received extracorporeal membrane oxygenation support for more than 24 hours. Patients with end stage renal disease on maintenance hemodialysis were excluded. Acute kidney injury was diagnosed and staged according to the Kidney Disease Improving Global Outcomes criteria. Demographic data, clinical characteristics, need for renal replacement therapy, and outcomes were analyzed. Results: Among the 45 patients, 12 patients or 26.66 percent developed acute kidney injury. Of these, 9 patients or 75 percent developed acute kidney injury within the first 24 hours of extracorporeal membrane oxygenation initiation. Sepsis, requirement of inotropic support, and poor cardiac function were identified as significant risk factors for acute kidney injury. Renal replacement therapy was required in all 12 patients with acute kidney injury. Severe acute kidney injury requiring continuous renal replacement therapy occurred in 4 patients or 33 percent of those with acute kidney injury. Overall mortality in the study population was 62.22 percent, which increased to 75 percent among patients who developed acute kidney injury. Among the three survivors with acute kidney injury, none required long term renal replacement therapy at discharge. Conclusion: Acute kidney injury is a common and serious complication during extracorporeal membrane oxygenation support and is associated with significantly increased mortality. Early identification of high risk patients, preventive strategies, and timely initiation of appropriate renal support may improve outcomes in this population.