Abstract
ObjectiveExtracorporeal membrane oxygenation (ECMO) requires systemic anticoagulation to maintain the circuit patency. However, the use of anticoagulation carries a risk of severe haemorrhage, necessitating rigorous monitoring. Activated clotting time (ACT) is a widely used monitoring tool, however the evidence on its correlation with unfractionated heparin (UFH) infusion dose is limited. Therefore, we aimed to analyse the correlation between ACT and UFH infusion during ECMO. DesignSystematic literature review and meta-analysis of correlation coefficients (Scopus and PubMed, up to July 13, 2024). PROSPERO: CRD42023448888 SettingAll retrospective and prospective studies ParticipantsPatients receiving ECMO support InterventionAnticoagulation monitoring during ECMO support Measurements and maim resultsNineteen studies were included in the analysis, and the meta-analysis encompassed 16. The vast majority of authors (n = 16) found a weak correlation, and none reported a strong correlation between ACT and UFH infusion dose. The meta-analysis (n = 12625 samples) identified a weak correlation, with the pooled estimate of correlation coefficients being 0.132 (95% CI 0.03; 0.23). Lastly, the most common adverse events were haemorrhage (pooled 45%) and thrombosis (30%), and 47% of patients died during the hospital stay. ConclusionsDespite ACT being a widely used UFH monitoring tool in ECMO patients, our meta-analysis found a weak correlation between ACT and UFH infusion dose. New trials are required to investigate the role of emerging tools and to clarify the most appropriate monitoring strategy for patients receiving ECMO support.
Published Version
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