Regional citrate anticoagulation for renal replacement therapy during venovenous extracorporeal membrane oxygenation (ECMO): A randomized crossover pilot study
Authors' conclusion
In patients undergoing VV ECMO, adding regional citrate anticoagulation to systemic unfractionated heparin reduced CRRT circuit clotting, prevented platelet consumption.
Study context
- Population
- Patients undergoing VV ECMO receiving continuous renal replacement therapy (CRRT)CRRT circuits from 18 patients
- Participants
- 66 patients
- Comparison
- Regional citrate anticoagulation (RCA) + unfractionated heparin (UFH) vs UFH
- RCA + UFHn = 33
- UFHn = 33reference
- Primary endpoint
- CRRT circuit clotting (circuits maintained up to 72 h or until clotting)
Primary result
As reported in the abstract
CRRT circuit clotting events
P < 0.001
Further findings
Circuit-level TEG R-time
P < 0.001
| Outcome | RCA + UFH | UFH | Estimate | P value |
|---|---|---|---|---|
| Circuit survival (Cox proportional hazards)Significantly longer circuit survival with RCA + UFH | P = 0.029 | |||
| Platelet count change | median +6 ×10³/μL | median −7 ×10³/μL | P < 0.001 | |
| Platelet count changeOverall trend | effect estimate +13 × 10³/μL (95% CI 8–19) | |||
| D-dimer levels | effect estimate −782 μg/L (95% CI −1525 to −39) |
- D-dimer levels: significant increase with UFH alone; lower increase with RCA + UFH
Safety
- No clinically relevant RCA-related metabolic complications; no episodes of severe hypernatremia, metabolic alkalosis or citrate accumulation
Original publication
Regional citrate anticoagulation for renal replacement therapy during venovenous ECMO: A randomized crossover pilot study. Ann Intensive Care. Published 27 April 2026. doi:10.
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