JNEPHROL 2008; 21: 789-792 CASE REPORT 789 ABSTRACT Acute renal failure during extracorporeal membrane oxy- genation (ECMO) support is associated with extremely high mortality. This report describes treatment of my- ocardial dysfunction in one 48-year-old and one 11-year- old patient. Venoarterial ECMO was required to support myocardial dysfunction. Continuous venovenous he- modialysis was performed for acute renal failure with pulmonary edema and oliguria. Both patients survived following treatment with venoarterial ECMO combined with continuous venovenous hemodialysis. Key words: Acute renal failure, CRRT, ECMO INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is effective in severe, reversible myocardial dysfunction (e.g., myocarditis, cardiomyopathy or postoperative cardiogenic shock) or for providing a bridge to another treatment modality. The com- monly observed decreased urine output during ECMO may be associated with acute renal failure. In this context, contin- uous renal replacement therapy (CRRT) should be consid- ered. The major advantage of CRRT is the slower rate of solute or fluid removal per unit of time. Thus, CRRT is gener- ally more tolerable than conventional therapy in critically ill patients, because many complications of intermittent hemodialysis are related to rapid solute and fluid loss. Reports indicate a grave prognosis for ECMO patients. Acute renal failure (ARF) developing during ECMO is associated with a very poor outcome (1, 2), possibly due to accumulated extravascular water causing interstitial overload, impaired oxygen transport through tissues and increased extravascular lung water volume with impaired O 2 transport. Increased water is itself associated with subsequent organ dysfunction, particularly in the heart, lungs and brain (3). As reported in a previous study by this team, 21 patients treated by CRRT and ECMO eventually died (1, 3). Combined CRRT and ECMO treatment is a therapeutic alternative for bridging temporary replacement treatment and heart trans- plantation in advanced cardiac patients (1, 3). This report describes the successful use of ECMO and continuous ven- ovenous hemodialysis (CVVHD) to treat 2 patients with myocardial dysfunction complicating acute renal failure. Chan-Yu Lin 1 , Yung-Chang Chen 1 , Feng-Chun Tsai 2 , Ya-Chung Tian 1 , Chang-Chyi Jenq 1 , Chung-Chi Huang 3 , Ji-Tseng Fang 1 , Chih-Wei Yang 1 1 Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan - ROC 2 Section of Cardiac Surgery, Chang Gung Memorial Hospital and Respiratory Care Department, Chang Gung Institute of Technology, Chia-Yi, Taiwan - ROC 3 Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan - ROC Continuous renal replacement therapy combined with extracorporeal membrane oxygenation in advanced cardiac failure patients www.sin-italy.org/jnonline – www.jnephrol.com