Kidney Week

Abstract: TH-PO0883

CRRT-Extracorporeal Membrane Oxygenation (ECMO): Novel Veno-Venous (VV)/Veno-Arterial (VA) Circuit Integration with Increased Filter Lifespan

Session Information

• Dialysis: Prescription, Physiology, and Treatment Optimization
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Rai, Balaj, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Balaj Rai, MD

• Greco, Jessica M., The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Jessica M. Greco, MD

• Kopanczyk, Rafal, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Rafal Kopanczyk, DO

• Chucta, Sheila, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Sheila Chucta, APRN, CNS, DNP

• Kirkland, Lauren, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

Lauren Kirkland, CCRN, RN

Background

For patients on ECMO, CRRT is the preferred modality to provide renal support. Unfortunately, this presents several challenges, including significant differences in flow and pressure dynamics, circuit thrombosis leading to reduced filter lifespan, reduced blood flow, and more frequent CRRT interruptions.¹ The median CRRT filter lifespan can last from 26-47 hours, depending on anticoagulation and integration.^2,3 In this study, we present an integrated pigtail configuration that prolongs filter life and reduces CRRT interruptions.

Methods

We used NxStage® CVVHD machines with Optiflux® high-flux filters. Figure 1 shows the circuit layout. We analyzed filter times for 50 patients on VV or VA ECMO with integrated CRRT circuits. The control filter lifespan was 44 ± 8 hours based on literature review.^3,4 Patients who survived less than 36 hours were excluded. Filters were excluded from the analysis if the life span was less than 36 hours AND machine error, patient death, decannulation, prolonged procedure, or inappropriate cessation.

Results

The median filter lifespan was 41.8 hours with an IQR of 33.5-44.7 hours. The average blood flow rate was 294 mL/min. 72.2 % of filters achieved an adequate lifespan of 36 hours. Filters lasted less than 10 hours 3.6 %, 10-24 hours 11.7 % and 24-36 hours 12.5 %, 36+ hours 72.2 %. Subgroup analyses will be discussed in future updates.

Conclusion

ECMO pressures determine CRRT pressures. The ECMO pump outflow is the driving pressure for the CRRT inflow, and the negative pressure from the ECMO inflow helps pull the CRRT outflow. With a max CRRT filter pressure ~ 400mmHg, the parallel channel also helps reduce resistance across the circuit, thus reducing shear stress.⁵ With the increased filter lifespan, circuit interruptions are reduced, thereby reducing the risk of hemodynamic instability, blood loss, clotting, and infection. Theoretically, this setup can work with the newer CVVHDF machines.