Continuous Renal Replacement Therapy and Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock: A Multicenter Observational Study: Results from the RESCUE Registry

Abstract Backgrounds: Cardiogenic shock (CS) frequently leads to multiorgan failure, potentially necessitating either continuous renal replacement therapy (CRRT) or extracorporeal membrane oxygenation (ECMO). However, there is a lack of comprehensive studies investigating the association between CRRT and ECMO in patients with CS. This study aimed to assess the effects of CRRT and ECMO in Korean patients with CS. Methods A total of 1,247 patients with CS were enrolled from the RESCUE (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With Cardiogenic Shock) registry, a multicenter, observational cohort enrolled between January 2014 and December 2018. The primary outcomes, including the 72-hour and 30-day all-cause mortality rates, were analyzed in relation to the use of ECMO and CRRT among CS patients. Results Among the cohort of 751 patients who did not undergo ECMO, 90 (12%) received CRRT, while among the 496 patients who underwent ECMO, 195 (39.3%) received CRRT. Irrespective of ECMO utilization, patients receiving CRRT exhibited elevated 30-day mortality rates. Nonetheless, among ECMO patients, those who received CRRT had a lower 72-hour mortality rate than did those who did not (19.6% versus 12.3%; p = 0.045). Multivariate Cox regression analysis revealed that the lactate level and vasoactive-inotrope score were consistent independent predictors of both 72-hour and 30-day mortality, regardless of ECMO or CRRT administration. However, CRRT emerged as a significant factor in mitigating the risk of 72-hour mortality among ECMO patients (hazard ratio 0.44; 95% confidence interval 0.21–0.91; p = 0.027). Conclusion Patients with CS who underwent CRRT had higher 30-day all-cause mortality rates than those who did not, irrespective of ECMO utilization. Among CS patients undergoing ECMO, CRRT was more frequently administered, suggesting that implementing CRRT might potentially improve early in-hospital mortality. Clinical Trial Registration : URL: https://www.clinicaltrials.gov; Unique identifier: NCT02985008. 2016.12.05.