Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, 15355 Ansan, Republic of Korea.
Rev Cardiovasc Med. 2021 Dec 22;22(4):1589-1594. doi: 10.31083/j.rcm2204164.
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%, = 0.452) and discharge (50% vs. 41.4%, = 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.
最佳抗凝对于体外膜肺氧合（ECMO）的成功至关重要，可抵消血液-生物表面反应和机械应激引发的凝血系统激活。全身抗凝主要采用未分馏肝素（UFH）。活化凝血时间（ACT）是监测抗凝的常用实验室参数。ACT 的治疗范围为 180-220 秒。我们研究了 ECMO 期间较低的目标 ACT（<150 s）对安全性和结局的影响，并将其与传统的目标 ACT（180-200 s）进行了比较。在这项单中心回顾性研究中，我们回顾了 2017 年 3 月至 2019 年 10 月期间接受 ECMO 治疗的 72 例成年患者。应用排除标准后，我们纳入了 43 例患者，并将他们分为低 ACT 组（<150 s，n=14，32.6%）和常规 ACT 组（≥150 s，n=29，67.4%）。两组患者 ECMO 支持成功撤机率（50% vs. 62.1%，=0.452）和出院率（50% vs. 41.4%，=0.594）无差异。常规 ACT 组中有 1 例患者发生颅内出血。血栓栓塞性并发症 1 例，发生在回路内血栓。迄今为止，抗凝在 ECMO 期间仍然是一个挑战。我们的结果表明，较低的 ACT 目标不一定会增加 ECMO 管理期间的血栓栓塞风险。临床医生可能会考虑对某些患者进行抗凝治疗，采用较低的 ACT 目标，并进行仔细评估和密切监测。需要进一步的前瞻性试验来验证这些结果。
