Search

Abstract: Introduction: Acute kidney injury (AKI) is one of the major complications in adult postcardiotomy patients on extracorporeal membrane oxygenation (ECMO) support. The RIFLE (the Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function and End-Stage Kidney Disease) classification and the Acute Kidney Injury Network (AKIN) criteria were proposed to identify and classify AKI recently. This study aims to evaluate the occurrence of AKI during the initial 48h of ECMO support by using both the RIFLE classification and the AKIN criteria, and to determine which scoring tool has better capability for predicting hospital mortality of adult postcardiotomy patients with ECMO support. Methods: From 2004 to 2008, 67 patients (≥18years) who received extracorporeal membrane oxygenation support after undergoing cardiac surgery were enrolled and retrospectively evaluated. Results: The average age was 50.5±13.6 years; 48 patients (72%) were male. According to the RIFLE classification and the AKIN criteria, the incidence of AKI during first 48h after receiving ECMO support was 81% and 85%, respectively. The overall mortality was 51% and the hospital mortality was much higher among patients who received renal replacement therapy (RRT) than in patients not receiving RRT (73% vs 32%, p =0.001). Either class-Failure for the RIFLE classification (odds ratio (OR)=12.6, 95% confidence interval (CI)=2.2–72.3, p =0.005) or the Stage 3 for the AKIN (OR=30.8, 95% CI=3.3–287.2, p =0.003) was found to be independently associated with the hospital mortality. The area under the receiver operator characteristic (ROC) curve for hospital mortality was 0.738 for the RIFLE classification (p =0.001) and was 0.799 for the AKIN criteria (p <0.001). No significant differences were found in both the incidence of AKI and the hospital mortality of AKI by using the RIFLE/AKIN criteria. Conclusions: Acute kidney injury is a major complication and associated with high mortality in adult patients who received ECMO support after undergoing cardiac surgery. Both the RIFLE classification and the AKIN criteria have good short-term prognostic capability in these populations and either class-Failure for the RIFLE classification or the Stage 3 for the AKIN were found to be independently associated with the hospital mortality. However, it does not seem that the AKIN criteria have greater sensitivity and specificity, compared with the RIFLE classification in this study population. [Copyright &y& Elsevier]

Aims: To establish a simple criterion for determining a failed His-bundle pacing (HBP). This criterion states that if stimulus to QRS end interval is longer than His-bundle potential to QRS end interval ('S-QRSend > H-QRSend') then a failed HBP can be determined., Methods and Results: We performed retrospective analysis on 737 pacing tests around His-bundle in 241 patients and prospective analysis on 400 tests in 123 patients. A successful HBP is defined as that whole His-bundle is captured with or without capture of adjacent ventricular myocardium, otherwise, a failed HBP was considered. The output criteria and effective refractory period criteria were used as the gold standards for determining a successful HBP. The gold standards are that if decreasing the pacing output or pacing cycle length to a certain level results in duration or morphology changes of QRS, then a successful HBP is ascertained. In retrospective analysis of patients with normal His-Purkinje conduction, a failed HBP was determined in 31% (154/492) of pacing tests according to 'S-QRSend > H-QRSend'; all of them were validated by the gold standards (specificity = 100%). In prospective study, a failed HBP was confirmed according to the simple criterion with 100% accuracy in 33% (79/241) pacing tests. This simple criterion was also suitable for patients with His-Purkinje conduction disease although cases with 'S-QRSend > H-QRSend' rarely occurred., Conclusion: A failed HBP can be easily and reliably determined solely by 'S-QRSend > H-QRSend' in more than 30% pacing tests., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)