Point of care guided coagulation management in adult patients on ECMO: A systematic review and meta-analysis

Abstract

BackgroundDespite the advancements in extracorporeal membrane oxygenation (ECMO) technology, balancing the prevention of thrombosis and the risk of bleeding in patients on ECMO is still a significant challenge for physicians. This systematic review and meta-analysis aimed to assess the efficacy and safety of viscoelastic point-of-care (POC)-guided coagulation management in adult patients on ECMO. MethodsPubMed Medline, Embase, Scopus, Web of Science, and Cochrane Library databases were searched. After quality assessment, meta-analysis was carried out using random effects model, heterogeneity using I2 and publication bias using Doi and Funnel plots. ResultsA total of 1718 records were retrieved from the searches. Fifteen studies that enrolled a total of 583 participants met the inclusion criteria. Of those, 3 studies enrolling 181 subjects were eligible for meta-analysis. In patients managed with POC-guided algorithms, the odds were coherently lower for bleeding (OR 0.71, 95%CI 0.36–1.42), thrombosis (OR 0.91, 95%CI 0.32–2.60), and in-hospital mortality (OR 0.54, 95%CI 0.29–1.03), but not for circuit change or failure (OR 1.50, 95%CI 0.59–3.83). However, the differences were not statistically significant due to wide 95%CIs. ConclusionViscoelastic POC monitoring demonstrates potential benefits for coagulation management in ECMO patients. Future research should focus on standardizing evidence to improve clinical decision-making. RegistrationThe protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023486294.