The comparison of circuit lifespan between integration and separation approach in extracorporeal membrane oxygenation patients requiring continuous renal replacement therapy support: a randomized controlled trial (E-CRRT Trial).

Abstract

The estimated incidence of acute kidney injury requiring renal replacement therapy (RRT), mainly continuous RRT (CRRT), in patients necessitating extracorporeal membrane oxygenation (ECMO) is approximately 50%. Currently, two well-known techniques, integration and separation, are utilized for combining CRRT and ECMO circuits, neither of which is considered a standard treatment. This study aimed to compare circuit lifespan of CRRT between these two techniques during ECMO support. A multicentered randomized controlled trial was conducted from May 2021 to March 2025. ECMO patients who required CRRT support were enrolled. Primary outcome was CRRT circuit lifespan. Eighty patients were recruited, with 40 allocated to the integration group and 40 to the separation group. Median circuit lifespan did not significantly differ between the groups (72 h [IQR 45-96.5] vs. 71 h [IQR 45-84]; p = 0.52). Twenty-eight-day mortality rates were also comparable (32.5% vs. 35%; p = 0.81). No significant differences were observed in the incidence of serious adverse events, including air embolism. Transmembrane pressure and CRRT machine alarm frequencies were similar between groups. Among critically ill ECMO patients receiving CRRT, there is no significant difference in filter lifespan and serious adverse events between integrating the CRRT circuit into the ECMO circuit and using a separate circuit. NCT05036616.