The multicenter randomized controlled E-CRRT Trial, conducted from May 2021 to March 2025 at King Chulalongkorn Memorial Hospital (KCMH) and Central Chest Institute of Thailand (CCIT), compared two strategies for combining continuous renal replacement therapy (CRRT) with extracorporeal membrane oxygenation (ECMO) in critically ill patients.

Eighty adult patients requiring both ECMO and CRRT were randomized 1:1 to either the integration approach (CRRT circuit spliced into the ECMO circuit) or the separation approach (independent CRRT circuit with dedicated vascular access).

Baseline characteristics, including age, sex, illness severity scores, ECMO indications, and acute kidney injury (AKI) causes, were well-balanced. Fluid overload (46.3%) and refractory metabolic acidosis (25%) were the leading reasons for CRRT initiation.

The primary outcome—median CRRT circuit (filter) lifespan—showed no significant difference between groups: 72 hours (IQR 45–96.5) in the integration arm versus 71 hours (IQR 45–84) in the separation arm (p=0.52). Secondary outcomes were similarly comparable, with 28-day mortality rates of 32.5% versus 35% (p=0.81), no differences in serious adverse events (including air embolism), transmembrane pressures, or CRRT machine alarm frequencies.

Crossover occurred in one integration patient (due to high access pressures at ECMO flows >4 L/min) and nine separation patients (mainly due to unavailable or unsafe vascular access sites occupied by multiple lines/catheters).

These findings suggest that both techniques are equally effective and safe for CRRT delivery during ECMO, with the choice potentially guided by practical factors such as vascular access availability rather than anticipated circuit longevity or complication risk. Larger studies may further refine patient selection for each approach.

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