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

• Published in: Journal of critical care Vol. 83; p. 154830
• Main Authors: Saracoglu, Ayten, Fawzy, Ibrahim, Saracoglu, Kemal Tolga, Abdallah, Bushra M, Arif, Mariah, Schmidt, Matthieu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2024; Elsevier Limited
• Subjects: Adult; Adults; Anticoagulation; Bleeding; Blood Coagulation; Clinical outcomes; Clinical trials; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - adverse effects; Extracorporeal Membrane Oxygenation - methods; Hemorrhage; Hemorrhage - therapy; Hospital Mortality; Humans; Medical Subject Headings-MeSH; Meta-analysis; Mortality; Point-of-Care Systems; Rotational thromboelastometry; Systematic review; Thromboelastography; Thrombosis; Thrombosis - etiology; Thrombosis - prevention & control; Viscoelastic test; Viscoelasticity; Rotational thromboelastometry; Thromboelastography; Extracorporeal membrane oxygenation; Viscoelastic test; Anticoagulation; Thrombosis; Bleeding
• ISSN: 0883-9441; 1557-8615; 1557-8615
• DOI: 10.1016/j.jcrc.2024.154830

Despite 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.
PubMed 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.
A 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.
Viscoelastic POC monitoring demonstrates potential benefits for coagulation management in ECMO patients. Future research should focus on standardizing evidence to improve clinical decision-making.
The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023486294.
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•Balancing thrombosis and bleeding remains a significant challenge in ECMO management.•Point-of-care (POC) viscoelastic management shows a trend toward reduced bleeding and thrombosis events.•POC-guided strategies demonstrate potential benefits for coagulation management in ECMO patients.•Future research should focus on standardizing evidence to improve clinical decision-making.