Figure 4 Fluid balance during VA-ECMO and CRRT supportFluid balance and urine output during the first 4 days following admission. VA-ECMO was initiated at 18: 00 hours and CRRT at 20: 00 h on day 1. Both of these were discontinued on day 4. IV fluids consisted predominantly of crystalloid solutions (lactated Ringer’s solution) for resuscitation and maintenance. Transfusion support (red blood cell concentrate: 2 units, fresh frozen plasma: 20 units) was required because of coagulopathy and bleeding. Continuous renal replacement therapy was performed without ultrafiltration for metabolic correction of severe acidosis and electrolyte imbalances. A progressive improvement in urine output was observed from day 2, which indicated renal function recovery. The net fluid balance became negative by day 3, which reflected successful volume management and restoration of renal function. VA-ECMO – veno-arterial extracorporeal membrane oxygenation; CRRT – continuous renal replacement therapy; IV – intravenous.