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Satisfactory outcome with activated clotting time <160 seconds in extracorporeal cardiopulmonary resuscitationopen access

Authors
Kim, Beong KiHong, Jeong InHwang, JinwookShin, Hong Ju
Issue Date
Sep-2022
Publisher
Lippincott Williams & Wilkins Ltd.
Keywords
activated clotting time; anticoagulation; complication; extracorporeal cardiopulmonary resuscitation; extracorporeal circulation; outcome
Citation
Medicine, v.101, no.37, pp E30568
Indexed
SCIE
SCOPUS
Journal Title
Medicine
Volume
101
Number
37
Start Page
E30568
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/61527
DOI
10.1097/MD.0000000000030568
ISSN
0025-7974
1536-5964
Abstract
Patients undergoing cardiopulmonary resuscitation (CPR) prior to extracorporeal membrane oxygenation (ECMO) can have severely altered physiology, including that of the coagulation pathway. This could complicate the extracorporeal cardiopulmonary resuscitation (ECPR) management. We aimed to show that targeting an activated clotting time (ACT) < 160 seconds does not affect the complication rates in these patients. In this single-centered retrospective study, the medical records of 81 adult patients who were on ECMO support from March 2017 to March 2020 were reviewed. We compared the low ACT and conventional ACT groups, which were defined on the basis of the median of the ACT values of the included patients (160 seconds). The primary outcomes included bleeding or thromboembolic events. This study included 32 patients, who were divided into the low (n = 14) and conventional (n = 18) ACT groups. There were 2 cases of gastrointestinal bleeding (P = .183), one of intracranial hemorrhage (P = .437), and one of peripheral skin color change (P = .437) in the low ACT group. There was one case of prolonged bleeding at the cannulation site (P = 1.000) reported in the conventional ACT group. The successful weaning rate differed significantly between the low and conventional ACT groups (92.9% vs 50.0%; P = .019). Maintaining the ACT lower than the conventional ACT in patients requiring ECPR did not show a significant increase in the thromboembolic risk. Therefore, targeting a low ACT should be considered for this particular group of patients.
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2. Clinical Science > Department of Thoracic and Cardiovascular Surgery > 1. Journal Articles
2. Clinical Science > Department of Pulmonary, Allergy, and Critical Care Medicine > 1. Journal Articles

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Kim, Beong Ki
Ansan Hospital (Department of Pulmonary, Allergy, and Critical Care Medicine, Ansan Hospital)
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