Abstract: Extracorporeal membrane oxygenation (ECMO) is mainly used in clinical practice to support cardiac insufficiency and/or respiratory insufficiency, and is a key technology for the treatment of severe and intractable heart failure and respiratory failure. During ECMO, fluid overload is frequently an indication for renal replacement therapy, and continuous renal replacement therapy (CRRT) is the commonly used modality. In patients on ECMO treatment, CRRT can be run in parallel with ECMO through different vascular access, or series connection in ECMO circuit. Anticoagulation for ECMO is usually with systemic heparin, but for CRRT circuit several methods can be used, such as no anticoagulation, addition of filtered heparin or local citrate anticoagulation. CRRT in combination with ECMO can be considered as a form of multi-organ supportive therapy, but this approach needs to be optimized in terms of timing, settings, anticoagulation, prescribing, and delivery. This review summarizes the implications of ECMO plus CRRT in adults, the timing of CRRT initiation, CRRT prescribing, circuit connection and prognosis in order to provide references for clinicians to treat the patients with appropriate indications.

Key words: Extracorporeal membrane oxygenation, Continuous renal replacement therapy, Multi-organ supportive therapy, Fluid overload, Anticoagulation, Connection modality