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

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

doi:10.1016/j.jcrc.2024.154830

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

J Crit Care. 2024 May 13:83:154830. doi: 10.1016/j.jcrc.2024.154830. Online ahead of print.

Authors

Ayten Saracoglu¹, Ibrahim Fawzy², Kemal Tolga Saracoglu³, Bushra M Abdallah⁴, Mariah Arif⁴, Matthieu Schmidt⁵

Affiliations

¹ Department of Anaesthesiology, ICU, and Perioperative Medicine, Aisha Bint Hamad Al-Attiyah Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, QU Health, Qatar University, Doha, Qatar. Electronic address: saracogluayten@gmail.com.
² Department of Critical Care Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.
³ College of Medicine, QU Health, Qatar University, Doha, Qatar; Department of Anaesthesiology, ICU, and Perioperative Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar.
⁴ College of Medicine, QU Health, Qatar University, Doha, Qatar.
⁵ Sorbonne Université, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France.

PMID: 38744017
DOI: 10.1016/j.jcrc.2024.154830

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: Viscoelastic POC monitoring demonstrates potential benefits for coagulation management in ECMO patients. Future research should focus on standardizing evidence to improve clinical decision-making.

Registration: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023486294.

Keywords: Anticoagulation; Bleeding; Extracorporeal membrane oxygenation; Rotational thromboelastometry; Thromboelastography; Thrombosis; Viscoelastic test.