{
  "abstract": "Background Extracorporeal membrane oxygenation (ECMO) is increasingly used to treat patients with severe cardiac and pulmonary failure but the complications of acute kidney injury and fluid overload are common. We aimed to determine whether the early initiation of continuous renal replacement therapy (CRRT) can reduce 30-day mortality in patients with ECMO.Methods The Evaluation of early CRRT intervention in patients with ECMO study was an investigator-initiated, multicentre, randomised, open clinical trial of patients undergoing ECMO who were randomly assigned to early initiation of CRRT (within 24 hours after ECMO) or conventionally indicated initiation of CRRT. All participants received standard diagnostic and therapeutic procedures. The primary endpoint was the 30-day mortality. A sample size of 500 patients was estimated to provide 80% power and a two-sided α of 0.05 to detect a 20% relative reduction in 30-day mortality assuming a rate of 70% in the usual care group. The primary analysis was unadjusted.Results The study stopped early due to feasibility. Of the 131 patients assessed for eligibility, 40 were excluded based on the inclusion and exclusion criteria. Of the 91 randomised patients, 46 were assigned to the early CRRT group and 45 were assigned to the usual care group. In the intervention group, 35 patients (76.1%) received CRRT within 24 hours post-ECMO implementation vs 15 patients (33.3%) in the usual care group. In the intention-to-treat analysis, the primary outcome occurred in 20 patients (43.5%) in the early CRRT group and 21 patients (46.7%) in the usual care group (HR 0.93, 95% CI 0.50 to 1.72; p=0.75). There was no significant difference in serious adverse events between the two groups (11 (25.6%) vs 9 (21.4%); OR 1.26, 95% CI 0.46 to 3.45; p=0.65).Conclusions Early implementation of CRRT in patients with ECMO showed no evidence of a difference in 30-day mortality compared with conventional initiation. However, the trial was substantially underpowered and clinically important benefits or harms cannot be excluded.Trial registration number NCT03549923.",
  "authors": [
    {
      "affiliations": [
        "The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China"
      ],
      "name": "Xiaofang Wang"
    },
    {
      "affiliations": [
        "The Second Affiliated Hospital, Zhengzhou University, Zhengzhou, China"
      ],
      "name": "Ying Liu"
    },
    {
      "affiliations": [
        "Beijing Anzhen Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Zhiyan Wang"
    },
    {
      "affiliations": [
        "Beijing Anzhen Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Hong Wang"
    },
    {
      "affiliations": [
        "Beijing Anzhen Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Chenglong Li"
    },
    {
      "affiliations": [
        "The Second Hospital of Jilin University, Changchun, China"
      ],
      "name": "Jiakun Tian"
    },
    {
      "affiliations": [
        "Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA"
      ],
      "name": "Chi Wang"
    },
    {
      "affiliations": [
        "The Second Affiliated Hospital, Zhengzhou University, Zhengzhou, China"
      ],
      "name": "Xiaojun Liu"
    },
    {
      "affiliations": [
        "The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China"
      ],
      "name": "Jun Li"
    },
    {
      "affiliations": [
        "The Second Hospital of Jilin University, Changchun, China"
      ],
      "name": "Yongjie Yin"
    },
    {
      "affiliations": [
        "Guangxi Zhuang Autonomous Region People's Hospital, Nanning, Guangxi, China"
      ],
      "name": "Liwen Lv"
    },
    {
      "affiliations": [
        "Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Yang Wu"
    },
    {
      "affiliations": [
        "Zhongshan City People’s Hospital, Zhongshan, China"
      ],
      "name": "Binfei Li"
    },
    {
      "affiliations": [
        "Sichuan Provincial People’s Hospital, Chengdu, China"
      ],
      "name": "Yiping Wang"
    },
    {
      "affiliations": [
        "Taizhou Hospital of Zhejiang Province, Linhai, China"
      ],
      "name": "Sheng Zhang"
    },
    {
      "affiliations": [
        "Zhongshan Hospital Affiliated to Fudan University, Shanghai, China"
      ],
      "name": "Xin Li"
    },
    {
      "affiliations": [
        "George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia",
        "Institute for Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China",
        "Heart Health Research Center, Beijing, China"
      ],
      "name": "Craig S Anderson"
    },
    {
      "affiliations": [
        "Beijing Anzhen Hospital, Capital Medical University, Beijing, China",
        "Heart Health Research Center, Beijing, China"
      ],
      "name": "Xin Du"
    },
    {
      "affiliations": [
        "The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China",
        "Beijing Anzhen Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Jianzeng Dong"
    },
    {
      "affiliations": [
        "Beijing Anzhen Hospital, Capital Medical University, Beijing, China"
      ],
      "name": "Xiaotong Hou"
    }
  ],
  "title": "Effects of early continuous renal replacement therapy in critically ill patients requiring ECMO treatment: results of a randomised controlled trial",
  "uid": "3a2adb2c-d626-5d53-bb80-2d2093e42137"
}