Impact of combined ECMO - CRRT support on patient outcomes and risk factors: a multicenter retrospective study

This study aimed to investigate the association of continuous renal replacement therapy (CRRT) use with the prognosis of patients undergoing extracorporeal membrane oxygenation (ECMO) and to explore its relationship with changes in blood cell components.

Data from four tertiary hospitals in China were retrospectively reviewed for patients who received ECMO support between September 2019 and June 2024. Univariable and multivariable logistic and Cox regression analyses were used to identify factors associated with in-hospital mortality. As an exploratory analysis, peripheral blood cell counts over the first 4 days after ECMO initiation were compared between groups, with hemoglobin and platelet values adjusted for transfusions.

Among 158 ECMO patients, 89 received CRRT and 69 did not, with an overall in-hospital mortality of 41.1%. Mortality was higher in the CRRT+ group than in the CRRT - group (53.9% vs. 24.6%, p < 0.05). CRRT use was independently associated with death (OR 3.61, 95% CI 1.49-8.77; p < 0.05), consistent with Cox regression (HR = 2.31, 95% CI: 1.30-4.12, p < 0.05). Subgroup analysis showed that CRRT use was associated with higher mortality among VA-ECMO patients (HR = 5.60, 95% CI: 1.67-18.83, p < 0.05), but not among VV-ECMO patients. CRRT+ patients exhibited more pronounced early declines in platelet and hemoglobin levels within the first 4 days after treatment initiation.

CRRT use was linked to poorer prognosis in ECMO patients, including higher in-hospital mortality, and was associated with marked changes in blood cell components.