The 36th Acute Disease Quality Initiative (ADQI) consensus meeting brought together critical care nephrology and ECMO experts to tackle the management of acute kidney injury (AKI), fluid balance (FB), and continuous renal replacement therapy (CRRT) in patients receiving ECMO.

Using a modified Delphi approach with high consensus, the panel established a foundational framework for clinical care. However, the proceedings starkly highlight a severe global shortage of multicenter clinical trials and high-quality evidence across all age groups, serving as a loud rallying cry for urgent interdisciplinary research.

A Framework Built on Expert Consensus: Due to a severe lack of robust clinical trial data across the lifespan (both pediatric and adult), many of the statements rely on the clinical expertise of a multidisciplinary panel rather than heavy empirical evidence.

A Foundation for Standardization: Despite the data gaps, these statements establish a crucial baseline to help ECMO centers standardize their care protocols and launch targeted quality improvement initiatives.

Acknowledged Limitations:

– Geographic Bias: Representation was heavily concentrated in the United States, with zero participants from Africa or Central America due to practical travel and financial constraints.
– Lack of Patient Voice: No patient representatives or advocacy groups were present, an omission the authors explicitly note must be corrected in future research and clinical trial designs.

The Path Forward: The 36th ADQI serves primarily as a launchpad. Its transparent mapping of existing knowledge gaps and research priorities is designed to ignite international, collaborative research to improve outcomes for the most critically ill patients.

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