Echocardiography for the evaluation of the relationship between lower abdominal aorta watershed and renal function injury during veno-arterial extracorporeal membrane oxygenation: A retrospective study

This investigation aims to elucidate the impact of echocardiography in assessing the association between the watershed region of the lower abdominal aorta and renal function impairment during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy. In this retrospective cohort study, patients who underwent VA-ECMO treatment for left heart failure at one hospital from March 2014 to November 2021 were included. Based on the position of the watershed in the lower abdominal aorta during ECMO therapy, according to echocardiography, subjects were categorized into 2 cohorts: the upper watershed group and the lower watershed group. The primary endpoint was an elevation in serum creatinine levels exceeding 133 μmol/L within 24 hours following the discontinuation of VA-ECMO. The cohort comprised 657 participants, with 437 allocated to the lower watershed group and 220 to the upper watershed group. No significant disparities were observed between the groups in terms of age ( P = .078), gender ( P = .638), and the underlying cause for VA-ECMO deployment ( P = .865). The likelihood of successful weaning from VA-ECMO was notably higher in the lower watershed group compared to the upper watershed group (97.0% vs 88.2%, P < .001). Conversely, the upper watershed group exhibited elevated mortality (8.2% vs 2.3%, P < .001) and renal failure (16.4% vs 4.1%, P < .001) rates. A significant difference in serum creatinine levels was recorded between the groups (β = 64.176, P < .001), with the upper watershed group demonstrating a higher association with serum creatinine levels exceeding 133 μmol/L within 24 hours post-VA-ECMO weaning (compared to the lower group, odds ratio = 15.206, 95% confidence interval: 9.791–23.616, P < .001). The echocardiographically determined position of the watershed above the lower abdominal aorta was found to be independently associated with an increased risk of serum creatinine levels exceeding 133 μmol/L within 24 hours after weaning from VA-ECMO. Additional multicenter, prospective validation studies are necessary to determine the exact causality between watershed position and ECMO weaning outcomes.