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)

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Abstract Title *

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)

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Co-author 1

Prasittiporn Tangjitaree pingmazz@gmail.com Excellence Center for Critical Care Nephrology King Chulalongkorn Memorial Hospital Bangkok Thailand *

Co-author 2

Peerapat Thanapongsatorn peerapat.manu@gmail.com Excellence Center for Critical Care Nephrology King Chulalongkorn Memorial Hospital Bangkok Thailand -

Co-author 3

Tanyapim Sinjira drtanyapim@gmail.com Division of Critical Care Medicine Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital Bangkok Thailand -

Co-author 4

Ekkapong Surinrat kim.surinrat@gmail.com Cardiovascular and Intervention Department Department of Medicine, Central chest institute of Thailand Nonthaburi Thailand -

Co-author 5

Pompon Suttiruk oou_70@hotmail.com Excellence Center for Critical Care Nephrology King Chulalongkorn Memorial Hospital Bangkok Thailand -

Co-author 6

Nattachai Srisawat drnattachai@yahoo.com Excellence Center for Critical Care Nephrology King Chulalongkorn Memorial Hospital Bangkok Thailand -

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

The estimated incidence of acute kidney injury requiring continuous renal replacement therapy (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.

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.

Figure 2: The number of participants who meet the eligibility criteria, are excluded after screening, and are randomized into the study groups.

Table: Comparison of median CRRT circuit lifespan between integration and separation techniques

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.

Kewords