[Abstract] 1303: EFFECTS OF EXTRACORPOREAL MEMBRANE OXYGENATION ON INTRA-ABDOMINAL PRESSURE AND ACUTE KIDNEY INJURY

Learning Objectives: Acute kidney injury (AKI) is very common in pediatric patients on extracorporeal membrane oxygenation (ECMO) support. The exact mechanisms of development of AKI in patients on ECMO are unknown. We propose that AKI in patients on ECMO is associated with compromised renal perfusion secondary to increased intra-abdominal pressure (IAP).Methods: Single center pilot phase, prospective study of pediatric patients requiring ECMO excluding those with underlying renal disease. Demographics, IAP, mean arterial pressure (MAP), abdominal perfusion pressure (APP = MAP-IAP), baseline creatinine (Cr) and urine output (UOP) were collected for the first 7 days of ECMO or until discontinuation whichever was earlier. Incidence of intra-abdominal hypertension IAH (IAP ≥ 10mm Hg) and abdominal compartment syndrome ACS (IAP ≥ 20mm Hg) was calculated. Primary outcome was AKI, defined by using pediatric RIFLE (risk, injury, failure, loss or end-stage) and KDIGO (Kidney Disease: Improving Global Outcomes) definitions. Secondary outcomes were 28-day mortality and length of hospital stay (LOHS). Parametric and non-parametric tests were used for univariable analysis as appropriate. Results: The preliminary data presented here is based on the interim analysis of first 10 patients (target enrollment:40). 80% and 20% of patients developed IAH and ACS, respectively. 40% of patients developed AKI based on standard definitions. In univariable analysis, AKI patients had higher IAPs (30 ±6 vs 13±3 mmHg, mean ± SEM, p=0.019) and also a higher number of IAP measurements that were greater than 10 mmHg (5.7±2.6 vs 19.2±10.6, mean ± SEM, p=0.047). Patients with AKI had lower minimum APP (18±6 vs 36±5 mmHg, mean ± SEM, p=0.043). Median LOHS trended higher in the AKI group 65 (IQR=31-115) vs 27 (IQR=8-47) days, p=0.22) but did not meet statistical significance. 28-day mortality was 10% in overall cohort with no significant difference between AKI and Non-AKI groups. Conclusions: There appears to be a positive correlation between increased IAP and occurrence of AKI. Additional patients are being enrolled to validate this finding.