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\begin{document}

\title{Letter To The Editor: Long-Term Renal Function After Venoarterial
Extracorporeal Membrane Oxygenation.}



\author[1]{Rohit Kumar}%
\author[2]{Sunil Kumar}%
\affil[1]{Dow Medical College}%
\affil[2]{Liaquat University of Medical and Health Sciences}%


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  \date{May 08, 2024}


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\emph{Title Page:}

\textbf{Title:} Letter To The Editor: Long-Term Renal Function After
Venoarterial Extracorporeal Membrane Oxygenation.

\textbf{Article Type:} Letter To The Editor

\textbf{Correspondence:} 1. Rohit Kumar

Contact No: +923332669103 Email: rohitkella001@gmail.com

Institute: Dow Medical College

Address: Baba-e-urdu road, Karachi

\textbf{Co-Authors:} 2. Sunil Kumar

Contact No: +923008088669. Email: dr.sunilkumar@hotmail.com

Institute: Liaquat University of Medical and Health Sciences.

\textbf{Word Count:} 476

\textbf{Conflict of interest} : None

\textbf{Acknowledgment} : None

\textbf{Declaration:} None

\textbf{Disclosure} : None

\textbf{Funding} : None

\textbf{Letter:}

To the Editor,

We recently reviewed the article ``Long-term renal function after
venoarterial extracorporeal membrane oxygenation'' by Brian ayers MD et
al.\textsuperscript{1} with deep interest. The author's effort on this
vital topic is well-written. We concur with the study's conclusion that
veno-arterial extracorporeal membrane oxygenation patients are less
vulnerable to long-term dialysis. Concerns threaten the study's
validity.

Prior to the commencement of ECMO, critically ill patients who are
candidates for extracorporeal membrane oxygenation have a high risk of
developing AKI. In addition, ischemia/reperfusion and systemic
inflammation caused by blood contact to artificial surfaces may
exacerbate AKI during ECMO.A 2019 study decided to incorporate the
numerical value of these two variables for illustration purposes and
discovered a high correlation with renal damage. 3~As has been proven,
sepsis has a propensity to affect several organs and can culminate in
multi-organ failure. Therefore, the authors should have widened their
inclusion criteria, as disregarding patient characteristics may have
affected the study's results. For instance, a 2020 study decided to
integrate SAPS11 and SOFA (sepsis-related organ failure assessment)
scores as extra patient variables to bolster their research. Secondly,
plasma-free hemoglobin level is highly related with a higher likelihood
of renal damage. Consequently, the authors should have addressed the
patient's plasma-free hemoglobin levels and the amount of blood units
required during extracorporeal membrane oxygenation.

Prior to the commencement of extracorporeal support, critically ill
patients who are candidates for ECMO are at high risk for developing
AKI. Even though blood flow is nonpulsatile during VAECMO, the increased
renal blood flow may aid in kidney recovery. Evaluating a patient's
24-hour urine production has proven to be a reliable predictor of
patient mortality. A 2016 study, for example, used 24-hour urine
collection as a patient variable. It was suggested that assessing short-
and long-term mortality in patients having extracorporeal membrane
oxygenation by analyzing 24-hour urine samples can lead to a dramatic
improvement in the health of patients undergoing extracorporeal membrane
oxygenation.\textsuperscript{5} To reduce renal impairment in patients
undergoing extracorporeal membrane oxygenation, it is necessary to
undertake more investigations from a variety of
angles.\textsuperscript{5} In contrast, variables such as
ischemia/reperfusion and systemic inflammation caused by blood contact
to artificial surfaces may exacerbate AKI during ECMO. AKI is therefore
prevalent in ECMO patients, although its frequency and impact on
prognosis are extremely diverse and largely dependent on the categories
used to identify renal failure, the rationale for ECMO, and the patient
groups studied. Moreover, neurological evaluation is associated with
different outcomes in patients undergoing extracorporeal membrane
oxygenation. The author's in their study failed to process their
participants through neurological evaluation. For example, a 2020 study
at regular intervals did a neurological evaluation such as pupil sizes,
reactivity to light, and brain stem reflexes and found out that patients
with acute cerebral strokes tend to have recurrent chronic kidney
disease and a more extended stay in ICU.\textsuperscript{4}

\textbf{References:}

\textbf{1-} Ayers B, Bjelic M, Kumar N, Wood K, Barrus B, Prasad S,
Gosev I. Long-term renal function after venoarterial extracorporeal
membrane oxygenation. J Card Surg. 2021 Mar;36(3):815-820. doi:
10.1111/jocs.15277. Epub 2021 Jan 8. PMID: 33416196.

\textbf{2-} Vinclair C, De Montmollin E, Sonneville R, Reuter J, Lebut
J, Cally R, Mourvillier B, Neuville M, Ruckly S, Timsit JF, Bouadma L.
Factors associated with major adverse kidney events in patients who
underwent veno-arterial extracorporeal membrane oxygenation. Ann
Intensive Care. 2020 Apr 20;10(1):44. doi: 10.1186/s13613-020-00656-w.
PMID: 32307616; PMCID: PMC7167383.

\textbf{3-} Pabst D, Sanchez-Cueva PA, Soleimani B, Brehm CE. Predictors
for acute and chronic renal failure and survival in patients supported
with veno-arterial extracorporeal membrane oxygenation. Perfusion. 2020
Jul;35(5):402-408. doi: 10.1177/0267659119889521. Epub 2019 Dec 2. PMID:
31789108.

\textbf{4-} Laimoud M, Alanazi M. The clinical significance of blood
lactate levels in evaluation of adult patients with veno-arterial
extracorporeal membrane oxygenation. Egypt Heart J. 2020 Oct
27;72(1):74. doi: 10.1186/s43044-020-00108-7. PMID: 33108534; PMCID:
PMC7588953.

\textbf{5-} Distelmaier K, Roth C, Binder C, Schrutka L, Schreiber C,
Hoffelner F, Heinz G, Lang IM, Maurer G, Koinig H, Steinlechner B,
Niessner A, Goliasch G. Urinary Output Predicts Survival in Patients
Undergoing Extracorporeal Membrane Oxygenation Following Cardiovascular
Surgery. Crit Care Med. 2016 Mar;44(3):531-8. doi:
10.1097/CCM.0000000000001421. PMID: 26562346.

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