The comparison of circuit lifespan between integration and separation approach in extracorporeal membrane oxygenation (ECMO) patient requiring continuous renal replacement therapy (CRRT) support, (E-CRRT Trial)

Combination CRRT with ECMO

Authors

  • Prasittiporn Tangjitaree Division of Critical Care Medicine, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Critical Care Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 10400
  • Peerapat Thanapongsatorn Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 10400
  • Tanyapim Sinjira Division of Critical Care Medicine, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Critical Care Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 10400
  • Pongpon Suttiruk Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 10400
  • Nattachai Srisawat Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand, 10400

DOI:

https://doi.org/10.54205/ccc.v32.266578

Keywords:

CRRT, ECMO, Circuit, Combination, Integration

Abstract

Background: 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. The efficacy of these two techniques is still unknown. Therefore, this study aimed to compare the circuit lifespan of CRRT between the integration and separation techniques.

Methods: A multicentered randomized controlled study with an unblinded design will be conducted to determine circuit lifespan differences between integration and separation techniques.

Hypothesis: We hypothesize that the integration technique will yield a longer circuit lifespan for CRRT compared to the separation technique.

 Trial registration: NCT05036616

References

Zhou XL, Chen YH, Wang QY. A new approach combining venoarterial extracorporeal membrane oxygenation and CRRT for adults: a retrospective study. Int J Artif Organs. 2017;40:345-9.

Lin CY, Chen YC, Tsai FC, Tian YC, Jenq CC, Fang JT, et al. RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation. Nephrol Dial Transplant. 2006;21:2867-73.

Yan X, Jia S, Meng X, Dong P, Jia M, Wan J, et al. Acute kidney injury in adult postcardiotomy patients with extracorporeal membrane oxygenation: evaluation of the RIFLE classification and the Acute Kidney Injury Network criteria. Eur J Cardiothorac Surg. 2010;37:334-8.

Smith AH, Hardison DC, Worden CR, Fleming GM, Taylor MB. Acute renal failure during extracorporeal support in the pediatric cardiac patient. ASAIO J. 2009;55:412-6.

Marlice Van Dyk. The use of CRRT in ECMO patients. The Egyptian Journal of Critical Care Medicine 6. 2018: 95–100.

Kielstein JT, Heiden AM, Beutel G, Gottlieb J, Wiesner O, Hafer C, et al. Renal function and survival in 200 patients undergoing ECMO therapy. Nephrol Dial Transplant. 2013;28:86-90.

Aubron C, Cheng AC, Pilcher D, Leong T, Magrin G, Cooper DJ, et al. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study. Crit Care. 2013;17:R73.

Haneya A, Diez C, Philipp A, Bein T, Mueller T, Schmid C, et al. Impact of Acute Kidney Injury on Outcome in Patients With Severe Acute Respiratory Failure Receiving Extracorporeal Membrane Oxygenation. Crit Care Med. 2015;43:1898-906.

Seczynska B, Krolikowski W, Nowak I, Jankowski M, Szuldrzynski K, Szczeklik W. Continuous renal replacement therapy during extracorporeal membrane oxygenation in patients treated in medical intensive care unit: technical considerations. Ther Apher Dial. 2014;18:523-34.

Chen H, Yu RG, Yin NN, Zhou JX. Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy in critically ill patients: a systematic review. Crit Care. 2014;18:675.

Austin D, McCanny P, Aneman A. Post-operative renal failure management in mechanical circulatory support patients. Ann Transl Med. 2020;8:833.

de Tymowski C, Desmard M, Lortat-Jacob B, Pellenc Q, Alkhoder S, Alouache A, et al. Impact of connecting continuous renal replacement therapy to the extracorporeal membrane oxygenation circuit. Anaesth Crit Care Pain Med. 2018;37:557-64.

Suga N, Matsumura Y, Abe R, Hattori N, Nakada TA, Oda S. A safe procedure for connecting a continuous renal replacement therapy device into an extracorporeal membrane oxygenation circuit. J Artif Organs. 2017;20:125-31.

Thy M, Augustin P, Tran-Dinh A, Montravers P, de Tymowski C. Renal Replacement Therapy for Patients Requiring Extracorporeal Membrane Oxygenation: A Multicenter International Survey. Blood Purif. 2022;51:899-906.

McMichael ABV, Ryerson LM, Ratano D, Fan E, Faraoni D, Annich GM. 2021 ELSO Adult and Pediatric Anticoagulation Guidelines. ASAIO J. 2022;68:303-10.

Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120:c179-84.

Bernard R. Fundamentals of biostatistics. 5th ed. Duxbery: Thomson learning; 2000:308.

Baxter. Prismaflex® Addendum to Operator’s Manual 2015 [cited 2015]. Available from: https://usrenalacute.baxter.com/sites/g/files/ebysai2526/files/2020-09/Prismaflex_7_xx_Operators_Manual.pdf.

Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Tubach F, Pons B, et al. Comparison of two strategies for initiating renal replacement therapy in the intensive care unit: study protocol for a randomized controlled trial (AKIKI). Trials. 2015;16:170.

Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bruyere R, et al. Timing of Renal-Replacement Therapy in Patients with Acute Kidney Injury and Sepsis. N Engl J Med. 2018;379:1431-42.

Ngamjarus C, Chongsuvivatwong V. n4Studies: Sample size and power calculations for iOS. The Royal Golden Jubilee Ph.D. Program - The Thailand Research Fund&Prince of Songkla University. 2014.

Downloads

Published

2024-03-25

How to Cite

1.
Tangjitaree P, Thanapongsatorn P, Sinjira T, Suttiruk P, Srisawat N. The comparison of circuit lifespan between integration and separation approach in extracorporeal membrane oxygenation (ECMO) patient requiring continuous renal replacement therapy (CRRT) support, (E-CRRT Trial): Combination CRRT with ECMO. Clin Crit Care [Internet]. 2024 Mar. 25 [cited 2024 Jul. 14];32(1):e240005. Available from: https://he02.tci-thaijo.org/index.php/ccc/article/view/266578

Issue

Section

Research Protocol