• Sasa Rajsic, Benedikt Treml, Dragana Jadzic, Robert Breitkopf, Christoph Oberleitner, Mirjam Bachler, Johannes Bösch, and Zoran Bukumiric.
• Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck 6020, Austria. Electronic address: sasa.rajsic@i-med.ac.at.
• J Crit Care. 2023 Oct 1; 77: 154332154332.

IntroductionThe initiation of the extracorporeal membrane oxygenation (ECMO) is associated with complex coagulatory and inflammatory processes and consequently needed anticoagulation. Systemic anticoagulation bears an additional risk of serious bleeding, and its monitoring is of immense importance. Therefore, our work aims to analyze the association of anticoagulation monitoring with bleeding during ECMO support.Material And MethodsSystematic literature review and meta-analysis, complying with the PRISMA guidelines (PROSPERO-CRD42022359465).ResultsSeventeen studies comprising 3249 patients were included in the final analysis. Patients experiencing hemorrhage had a longer activated partial thromboplastin time (aPTT), a longer ECMO duration, and higher mortality. We could not find strong evidence of any aPTT threshold association with the bleeding occurrence, as less than half of authors reported a potential relationship. Finally, we identified the acute kidney injury (66%, 233/356) and hemorrhage (46%, 469/1046) to be the most frequent adverse events, while almost one-half of patients did not survive to discharge (47%, 1192/2490).ConclusionThe aPTT-guided anticoagulation is still the standard of care in ECMO patients. We did not find strong evidence supporting the aPTT-guided monitoring during ECMO. Based on the weight of the available evidence, further randomized trials are crucial to clarify the best monitoring strategy.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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