Jeong In Hong, Jinwook Hwang and Hong Ju Shin*
Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, KoreaFulltext PDF
Backgrounds: Optimal anticoagulation is critical for successful extracorporeal membrane oxygenation (ECMO). Activated Clotting Time (ACT) is a widely used laboratory parameter to monitor anticoagulation. The therapeutic range of ACT is 180 s-220 s. We investigated the effect of a lower target ACT (<150 sec) during ECMO on safety and outcomes and compared it with those of a conventional target ACT (180 s-200 s). Study Design and Methods: In this retrospective study, we reviewed 72 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%). Results: 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. A patient in the conventional ACT group had intracranial hemorrhage. There was no thromboembolic complication, except in one patient where an intra-circuit thrombus was observed. Conclusion: A lower target ACT level did not increase the thromboembolic risk during ECMO management. Thus, clinicians may consider lower ACT management in patients at a high risk of hemorrhagic complications. Further randomized controlled are warranted to validate these results.
Extracorporeal circulation; Extracorporeal cardiopulmonary resuscitation; Activated clotting time; Complication; Survival to discharge
Hong JI, Hwang J, Shin HJ. Satisfactory Outcome with Low Activated Clotting Time (<150 Seconds) in Extracorporeal Membrane Oxygenation. Clin Surg. 2021; 6: 3274..