Details

Autor(en) / Beteiligte

• Saracoglu, Ayten
• Fawzy, Ibrahim
• Saracoglu, Kemal Tolga
• Abdallah, Bushra M
• Arif, Mariah
• Schmidt, Matthieu

Titel

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

Ist Teil von

• Journal of critical care, 2024-10, Vol.83, p.154830, Article 154830

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2024

Quelle

MEDLINE

Beschreibungen/Notizen

• 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. [Display omitted] •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.