Early Versus Standard Continuous Renal Replacement Therapy for Adults With Cardiogenic Shock on Veno-arterial ECMO and Acute Kidney Injury

What this Trial Is About

Researchers are evaluating the safety and effectiveness of early versus standard continuous renal replacement therapy CRRT in patients with advanced cardiogenic shock who develop acute kidney injury stage 2 or higher while on veno-arterial extracorporeal membrane oxygenation VA-ECMO. This trial aims to determine the best timing for starting CRRT to improve outcomes in this critically ill population, as previous observational studies have suggested benefits but no randomized trials have confirmed optimal timing. Participants will be randomly assigned to one of two groups an accelerated group where CRRT starts as soon as possible and within 6 hours after meeting eligibility, and a standard group where CRRT begins only if certain clinical criteria develop, such as severe potassium imbalance, metabolic acidosis, high blood urea nitrogen, or refractory fluid overload. These approaches will be compared to assess their impact on patient outcomes during the study period. During the trial, participants will be monitored for various clinical outcomes including mortality, dependence on renal replacement therapy at 90 days, successful weaning from VA-ECMO, bleeding events, duration of intensive care, and other complications. The study includes assessments up to 12 months after enrollment to track longer-term outcomes. Data collection involves clinical evaluations, laboratory tests, and monitoring of organ function over time to understand the effects of CRRT timing on recovery and survival.

Accelerated vs. Standard Continuous Renal Replacement Therapy for Patients With Cardiogenic Shock Undergoing Veno-arterial ExtraCorporeal Membrane Oxygenator