The Comparison of Circuit Lifespan between Integration and Separation Approach in Extracorporeal Membrane Oxygenation Patient Requiring Continuous Renal Replacement Therapy Support, A Randomized Controlled Trial (E-CRRT Trial)

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 hours [IQR 45–96.5] vs. 71 hours [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 with CRRT support, integrated CRRT circuit into ECMO circuit shows no significant difference in efficacy and serious adverse events when compared to separation technique. Trial registration NCT05036616