Use of Extracorporeal Membrane Oxygenation in Neonates with Congenital Anomalies of the Kidney and Urinary Tract: A Multicenter Survey of Current Practices Across CHNC Centers

Objective: Characterize practices and decision-making for extracorporeal membrane oxygenation (ECMO) for congenital anomalies of the kidney and urinary tract (CAKUT). Study Design: General Practices (GP) section inquired about institutional practices and barriers, ECMO criteria, and dialysis. The Hypothetical Cases (HC) illustrated four clinical scenarios with varying degrees of renal severity for ECMO candidacy. Results: 99 (42 centers) and 91 (38 centers) physicians completed the GP and HC components respectively. Majority considered ECMO on case-by-case basis (66%). Bilateral renal agenesis was most common diagnosis for exclusion (52%). Prenatal markers used for ECMO exclusion included anhydramnios (43%) and lung volumes (43%). Majority of centers had nephrology involved in ECMO decision-making. Challenges for implementing ECMO included disease heterogeneity (79%) and poor evidence on outcomes (66%). HC responses demonstrated variability in considering ECMO for CAKUT. Conclusions: Variability among providers and institutes underscores the need for consensus-based guidelines to optimize decision-making and outcomes.