Gorga SM, Sahay RD, Askenaz DJ, et al. - This research was intended to define continuous renal replacement therapy (CRRT) utilization on extracorporeal membrane oxygenation (ECMO) and to ascertain the relationship of both fluid overload (FO) at CRRT initiation and fluid removal during CRRT with mortality in a large multicenter cohort. Between January 1, 2007, and December 31, 2011, researchers designed a retrospective chart review to include all children < 18 years of age concurrently treated with ECMO and CRRT, at six tertiary care children’s hospital. Children treated with hemodialysis or peritoneal dialysis were excluded from the FO analysis. Of the 1009 children, a sum of 756 supported with ECMO during the study period had complete FO data. This study's findings indicates that severe FO was very common at CRRT initiation in a multicenter pediatric ECMO cohort. There was an independent correlation between the degree of FO at CRRT initiation with adverse outcomes including mortality and increased duration of ECMO support. The outcomes imply that intervening prior to the establishment of significant FO may be a clinical therapeutic target and warrants future research.