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
Background: 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.
Purpose: This study aimed to compare circuit lifespan of CRRT between these two techniques during ECMO support.
Methods: 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.
Results: 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.
Conclusion: 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.