13: Extracorporeal membrane oxygenation in diabetic ketoacidosis

Purpose: Diabetic ketoacidosis (DKA) is a common illness in the United States. Some patients develop severe shock and/or respiratory failure, and extracorporeal membrane oxygenation (ECMO) may be considered. This series describes the clinical presentation and outcomes of patients with DKA managed with ECMO. Materials and Methods: We conducted a retrospective review of 15 patients with DKA who required ECMO at our institution. Demographics and ECMO-specific data was collected. Additional variables included ICU length of stay, acute kidney injury, use of dialysis, disposition, and mortality. Results: All ECMO cannulations were performed by intensive care physicians. The majority of patients were female (73%) with a median age of 27 (IQR=21.5-45) years. A diagnosis of diabetes mellitus (DM) prior to ECMO was present in 11 (73%) patients. Veno-arterial ECMO was the initial mode used in 11 (73%) patients. The median duration of ECMO support was 7 (IQR=6-14) days. The median ICU length of stay was 12 (IQR=8.5-20.5) days, and the median hospital length of stay was 21 (IQR=11-36.5) days. Eight patients had cardiac arrest and underwent extracorporeal cardiopulmonary resuscitation (ECPR) of which four (50%) patients survived to discharge. Overall, 10 (66.7%) patients were successfully weaned from ECMO and survived to discharge. Conclusions: This is the largest case series regarding the use of ECMO for patients with refractory shock, cardiac arrest, or respiratory failure related to DKA. The findings suggest that ECMO is a viable support strategy for these patients. Further research is needed to identify optimal patient selection criteria and management strategies.