Archive | 2021
Anticoagulation Practices and Mortality in Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis
Abstract
\n Objective: This study sought to evaluate the effect of different anticoagulant methods on in-hospital mortality, bleeding, and thromboembolic complications of patients receiving extracorporeal cardiopulmonary resuscitation (ECPR).Data Sources: We searched the relevant literature concerning ECPR and anticoagulation indexed in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from 1995 until May 2020. Study Selection: The anticoagulation information and outcomes data (i.e., anticoagulation targets and strategy, major bleeding and thromboembolic events, and in-hospital mortality rate) were extracted. A random-effects meta-analysis was performed to analyze these data.Data Extraction: Twenty-seven studies (N = 1,302 patients) were included; of these, 16 studies (n = 672 patients) included data regarding bleeding and thromboembolic complications. Data Synthesis:The summary prevalence for in-hospital mortality was 70% [95% confidence interval (CI): 65%–74%, I2 = 68.3%], the summary prevalence for major bleeding was 27% (95% CI: 19%–35%, I2 = 84.1%), and the summary prevalence for thromboembolic events was 8.7% (95% CI: 5.2%–13.4%, I2 = 71.4%).Conclusions: Controversy persists regarding whether to administer loading heparin and in making the choice of target anticoagulant dose. Currently, limited evidence suggests that low target anticoagulant doses may benefit patients. There is a need for further investigation of optimal anticoagulation strategies in patients receiving ECPR, preferably in randomized trials or well-designed observational studies and with clearly defined outcomes.