• Sasa Rajsic, Daniel Schwaiger, Lukas Schausberger, Robert Breitkopf, Benedikt Treml, Dragana Jadzic, Christoph Oberleitner, and Zoran Bukumiric.
• Department of Anaesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
• J. Cardiothorac. Vasc. Anesth. 2024 Nov 1; 38 (11): 265126602651-2660.

ObjectiveExtracorporeal membrane oxygenation (ECMO) requires systemic anticoagulation to maintain the circuit patency. However, the use of anticoagulation carries a risk of severe hemorrhage, necessitating rigorous monitoring. Activated clotting time (ACT) is a widely used monitoring tool; however, the evidence of its correlation with unfractionated heparin (UFH) infusion dose is limited. Here we aimed to analyze the correlation between ACT and UFH infusion during ECMO.DesignSystematic literature review and meta-analysis of correlation coefficients (Scopus and PubMed, up to July 13, 2024).ProsperoCRD42023448888 SETTING: All retrospective and prospective studies PARTICIPANTS: Patients receiving ECMO support INTERVENTION: Anticoagulation monitoring during ECMO support MEASUREMENTS AND MAIN RESULTS: Nineteen studies were included in the analysis, and the meta-analysis encompassed 16 studies. The vast majority of studies (n = 15) found a weak correlation, and no study reported a strong correlation between ACT and UFH infusion dose. The meta-analysis (n = 12,625 samples) identified a weak correlation, with a pooled estimate of correlation coefficients of 0.132 (95% confidence interval 0.03-0.23). The most common adverse events were hemorrhage (pooled incidence, 45%) and thrombosis (30%), and 47% of the patients died during their hospital stay.ConclusionsEven though ACT is a widely used UFH monitoring tool in ECMO patients, our meta-analysis found a weak correlation between ACT and UFH infusion dose. New trials are needed to investigate the role of emerging tools and to clarify the most appropriate monitoring strategy for patients receiving ECMO support.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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