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End-organ dysfunction is associated with increased mortality in pediatric cardiac patients requiring extracorporeal support. We sought to characterize the odds of developing acute renal failure (ARF) as well as associated increases in mortality in this population. Records of all cardiac patients in our pediatric intensive care unit receiving extracorporeal membrane oxygenation (ECMO) over a 24 month period were reviewed for data with respect to their course. Acute renal failure was defined as fluid retention or electrolyte disturbance resulting in institution of continuous renal replacement therapy (CRRT), or a glomerular filtration rate (GFR) of <35 ml/min/1.73 m2. Analysis revealed 49 ECMO runs in 48 patients, with ARF present in 71.7%, and CRRT initiated in 58.7%. Odds for developing ARF increased by 60% per day of ECMO support (β 1.60, 95% CI 1.08–2.37, p = 0.018). Acute renal failure during ECMO, after adjusting for patient age, remained associated with a decrease in odds of survival to discharge (OR 4.7, 95% CI 1.10–20.4, p = 0.037). We conclude that ARF is more common among pediatric cardiac patients requiring extracorporeal support than previously recognized. Increasing duration of ECMO support is associated with development of ARF. Acute renal failure while on ECMO is associated with a significant decrease in the odds of survival in the pediatric cardiac patient.