Acute kidney injury is a major risk in coronavirus disease 2019 infected patients receiving extracorporeal membrane oxygenation (ECMO): single-center experience from the MENA region

Authors

AlOtaibi, Torki M.; Abbas, Ahmad; Nagib, Ayman M.; et al.

Citation

Arab J Nephrol Transplant. 2026;8(1):24–30.

Abstract

Background: Some reports criticizing the role of extracorporeal membrane oxygenation (ECMO) on the outcome of critically ill coronavirus disease 2019 (COVID-19) infected patients. Worldwide medical organizations- during early phase of pandemic- considered ECMO if standard of care treatment failed. To evaluate risk factors associated with the outcome of patients admitted to intensive care units with COVID-19 infection for ECMO procedure. Methods: In such an observational study, patients infected with COVID-19 who needed ECMO in Kuwait from March 1, 2020 to December 31, 2021 were enrolled. We recorded the following information for all patients: socio-demographics, clinico-laboratory factors, radiological results, and management strategies. Furthermore, major complications during ECMO procedure were reported especially bleeding/thrombotic events, blood product transfusions and acute kidney dysfunction. Final outcome was recorded with special stress on ECMO duration, ICU stay, patient outcome, and respiratory status on discharge. Results: The majority of patients (58.5%) in our cohort survived. Most of the nonsurvivors were males (P = 0.046), older (P = 0.01), with higher mean platelet volume, D-dimer and mean CO2 (P < 0.05). The majority of nonsurvivors (56.9%) had chest computed tomography findings matched with COVID-19 (P = 0.028). Besides, most of the nonsurvivors were hemodynamically unstable on vasopressors (89.2%) or developed AKI during the procedure of ECMO (78.5%), (P < 0.001, 0.012, respectively). The use of biological agents had improved the survival (75 vs. 49.5% in those who did not receive it, P = 0.038). ECMO duration correlated positively with patient age (P = 0.012). Besides, postdischarge O2 supplementation or CPAP was needed in 48.1 and 11.4%, respectively. Conclusion: ECMO must be indicated for critically sick COVID-19 infected cases with respiratory failure not responding to standard of care (SOC) management. We found that young age and treatment with biological agents were good omens for surviving while the mortality risk factors were diabetes, shock, AKI during the procedure, CT findings matched with COVID-19 pneumonia, and high arterial CO2.

Full text (excerpt)

Acute kidney injury is a major risk in coronavirus disease 2019 infected patients receiving extracorporeal membrane oxygenation (ECMO): single-center experience from the MENA region Torki M. AlOtaibiª, Ahmad Abbasª,b, Ayman M. Nagibª,c, Prasad Nairª, Medhat A Halimª, Mahmoud M. Khalidª, Mohamed A. Hammadª, Tarek S. Mahmoudª, Islam S. Elsawiª, Zakaria E. Zakariaª, Ahmed F. Attaª, Ahmed S. Derazª, Ahmed Y. Mostafaª, Mohamed M. Abuelmagdª, Mohamed Shakerª, Nabil Alserwyª, Zoheer A. Fayyadª, Mohamed Mostafaª, Suzann Ridaª, Hasaneen H. Aboatyª, Mohamed Adelª, Mohamed Balahaª, Khaled Ateaª, Amro Mahmoudª, Mohamed Dahabª, Sara Buabassª, Ahmed Saleh Kenawyª, Osama Gheithª,c ªHamed Alessa Organ Transplant Center, ᵇAnaesthesia Department, ᶜNephrology Department, Chest Hospital, Kuwait, ᵈChest Department, Zagazig University, Sharqia, ᵉUrology and Nephrology Center, Mansoura University, El Mansoura, F. Dakahlia Governorate, Egypt, ᵍHealth Outcomes Division, College of Pharmacy, University of Texas at Austin, Texas, USA Correspondence to Osama Gheith, MD, PhD, Consultant of Internal Medicine and Nephrology, Urology &amp; Nephrology Center, Mansoura University, Egypt; Nephrology Department, Hame

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The Arab Journal of Nephrology and Transplantation is the peer-reviewed open-access journal of ASNRT, published since 2008.

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