PMID- 34957799
OWN - NLM
STAT- MEDLINE
DCOM- 20220323
LR  - 20220323
IS  - 1530-6550 (Print)
IS  - 1530-6550 (Linking)
VI  - 22
IP  - 4
DP  - 2021 Dec 22
TI  - Satisfactory outcome with low activated clotting time in extracorporeal membrane 
      oxygenation.
PG  - 1589-1594
LID - 10.31083/j.rcm2204164 [doi]
AB  - Optimal anticoagulation is critical for successful extracorporeal membrane 
      oxygenation (ECMO) to counterbalance the activation of the coagulation system 
      initiated by the blood-biosurface reaction and mechanical stresses. Systemic 
      anticoagulation is achieved mainly with unfractionated heparin (UFH). Activated 
      clotting time (ACT) is a widely used laboratory parameter to monitor 
      anticoagulation. The therapeutic range of ACT is 180-220 s. We investigated the 
      effect of a lower target ACT (<150 s) during ECMO on safety and outcomes and 
      compared it with those of a conventional target ACT (180-200 s). In this 
      single-center, retrospective study, we reviewed 72 adult patients treated with 
      ECMO from March 2017 to October 2019. We included 43 patients after applying the 
      exclusion criteria and divided them into the low ACT group (<150 s, n = 14, 
      32.6%) and conventional ACT group (>/=150 s, n = 29, 67.4%). There was no 
      difference in the successful weaning from ECMO support (50% vs. 62.1%, p = 0.452) 
      and discharge (50% vs. 41.4%, p = 0.594) rates between the groups. One patient in 
      the conventional ACT group had intracranial hemorrhage. There was one 
      thromboembolic complication case with an intra-circuit thrombus. To date, 
      anticoagulation remains a challenge during ECMO. Our results suggest that a lower 
      target ACT does not necessarily increase the thromboembolic risk during ECMO 
      management. Clinicians may consider anticoagulation with lower ACT target for 
      some patients with careful assessment and close monitoring. Further prospective 
      trials are warranted to validate these results.
CI  - (c) 2021 The Author(s). Published by IMR Press.
FAU - Hong, Jeong In
AU  - Hong JI
AD  - Department of Thoracic and Cardiovascular Surgery, Korea University Ansan 
      Hospital, Korea University College of Medicine, 15355 Ansan, Republic of Korea.
FAU - Hwang, Jinwook
AU  - Hwang J
AD  - Department of Thoracic and Cardiovascular Surgery, Korea University Ansan 
      Hospital, Korea University College of Medicine, 15355 Ansan, Republic of Korea.
FAU - Shin, Hong Ju
AU  - Shin HJ
AD  - Department of Thoracic and Cardiovascular Surgery, Korea University Ansan 
      Hospital, Korea University College of Medicine, 15355 Ansan, Republic of Korea.
LA  - eng
GR  - K1924931/Korea University grant/
PT  - Journal Article
PL  - Singapore
TA  - Rev Cardiovasc Med
JT  - Reviews in cardiovascular medicine
JID - 100960007
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/adverse effects
MH  - Blood Coagulation
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Heparin/adverse effects
MH  - Humans
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Activated clotting time
OT  - Anticoagulation
OT  - Complication
OT  - Discharge survival
OT  - Extracorporeal cardiopulmonary resuscitation
OT  - Extracorporeal membrane oxygenation
COIS- The authors declare no conflict of interest.
EDAT- 2021/12/28 06:00
MHDA- 2022/03/24 06:00
CRDT- 2021/12/27 07:10
PHST- 2021/07/20 00:00 [received]
PHST- 2021/08/24 00:00 [revised]
PHST- 2021/09/10 00:00 [accepted]
PHST- 2021/12/27 07:10 [entrez]
PHST- 2021/12/28 06:00 [pubmed]
PHST- 2022/03/24 06:00 [medline]
AID - S1530-6550(21)00278-7 [pii]
AID - 10.31083/j.rcm2204164 [doi]
PST - ppublish
SO  - Rev Cardiovasc Med. 2021 Dec 22;22(4):1589-1594. doi: 10.31083/j.rcm2204164.