Abstract：
BACKGROUND: Despite the advancements in extracorporeal membrane oxygenation (ECMO) technology, balancing the prevention of thrombosis and the risk of bleeding in patients on ECMO is still a significant challenge for physicians. This systematic review and meta-analysis aimed to assess the efficacy and safety of viscoelastic point-of-care (POC)-guided coagulation management in adult patients on ECMO.
METHODS: PubMed Medline, Embase, Scopus, Web of Science, and Cochrane Library databases were searched. After quality assessment, meta-analysis was carried out using random effects model, heterogeneity using I2 and publication bias using Doi and Funnel plots.
RESULTS: A total of 1718 records were retrieved from the searches. Fifteen studies that enrolled a total of 583 participants met the inclusion criteria. Of those, 3 studies enrolling 181 subjects were eligible for meta-analysis. In patients managed with POC-guided algorithms, the odds were coherently lower for bleeding (OR 0.71, 95%CI 0.36-1.42), thrombosis (OR 0.91, 95%CI 0.32-2.60), and in-hospital mortality (OR 0.54, 95%CI 0.29-1.03), but not for circuit change or failure (OR 1.50, 95%CI 0.59-3.83). However, the differences were not statistically significant due to wide 95%CIs.
CONCLUSIONS: Viscoelastic POC monitoring demonstrates potential benefits for coagulation management in ECMO patients. Future research should focus on standardizing evidence to improve clinical decision-making.
BACKGROUND: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023486294.
METHODS: PubMed Medline, Embase, Scopus, Web of Science, and Cochrane Library databases were searched. After quality assessment, meta-analysis was carried out using random effects model, heterogeneity using I2 and publication bias using Doi and Funnel plots.
RESULTS: A total of 1718 records were retrieved from the searches. Fifteen studies that enrolled a total of 583 participants met the inclusion criteria. Of those, 3 studies enrolling 181 subjects were eligible for meta-analysis. In patients managed with POC-guided algorithms, the odds were coherently lower for bleeding (OR 0.71, 95%CI 0.36-1.42), thrombosis (OR 0.91, 95%CI 0.32-2.60), and in-hospital mortality (OR 0.54, 95%CI 0.29-1.03), but not for circuit change or failure (OR 1.50, 95%CI 0.59-3.83). However, the differences were not statistically significant due to wide 95%CIs.
CONCLUSIONS: Viscoelastic POC monitoring demonstrates potential benefits for coagulation management in ECMO patients. Future research should focus on standardizing evidence to improve clinical decision-making.
BACKGROUND: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023486294.
摘要：
背景：尽管体外膜氧合（ECMO）技术取得了进步，在ECMO患者中,平衡血栓形成的预防和出血风险仍然是医师面临的重大挑战.本系统评价和荟萃分析旨在评估在接受ECMO治疗的成年患者中粘弹性点护理（POC）指导的凝血管理的有效性和安全性。
方法：PubMedMedline，Embase,Scopus,WebofScience,搜索了Cochrane图书馆数据库。经过质量评估，使用随机效应模型进行荟萃分析，使用I2的异质性和使用Doi和漏斗图的出版偏倚。
结果：从检索中总共检索到1718条记录。共招募583名参与者的15项研究符合纳入标准。其中,纳入181名受试者的3项研究符合荟萃分析的条件。在使用POC引导算法管理的患者中，出血的几率一致较低(OR0.71，95CI0.36-1.42)，血栓形成（OR0.91，95CI0.32-2.60），和住院死亡率（OR0.54，95CI0.29-1.03），但不适用于电路变化或故障(OR1.50,95CI0.59-3.83)。然而,由于宽95CIs,差异无统计学意义.
结论：粘弹性POC监测显示ECMO患者凝血管理的潜在益处。未来的研究应集中在规范证据以改善临床决策。
背景：该方案已在国际前瞻性系统审查注册簿（PROSPERO）中注册，注册ID为CRD42023486294。
方法：PubMedMedline，Embase,Scopus,WebofScience,搜索了Cochrane图书馆数据库。经过质量评估，使用随机效应模型进行荟萃分析，使用I2的异质性和使用Doi和漏斗图的出版偏倚。
结果：从检索中总共检索到1718条记录。共招募583名参与者的15项研究符合纳入标准。其中,纳入181名受试者的3项研究符合荟萃分析的条件。在使用POC引导算法管理的患者中，出血的几率一致较低(OR0.71，95CI0.36-1.42)，血栓形成（OR0.91，95CI0.32-2.60），和住院死亡率（OR0.54，95CI0.29-1.03），但不适用于电路变化或故障(OR1.50,95CI0.59-3.83)。然而,由于宽95CIs,差异无统计学意义.
结论：粘弹性POC监测显示ECMO患者凝血管理的潜在益处。未来的研究应集中在规范证据以改善临床决策。
背景：该方案已在国际前瞻性系统审查注册簿（PROSPERO）中注册，注册ID为CRD42023486294。
