%0 Journal Article
%T Point of care guided coagulation management in adult patients on ECMO: A systematic review and meta-analysis.
%A Saracoglu A
%A Fawzy I
%A Saracoglu KT
%A Abdallah BM
%A Arif M
%A Schmidt M
%J J Crit Care
%V 83
%N 0
%D 2024 Oct 13
%M 38744017
%F 4.298
%R 10.1016/j.jcrc.2024.154830
%X <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>Viscoelastic POC monitoring demonstrates potential benefits for coagulation management in ECMO patients. Future research should focus on standardizing evidence to improve clinical decision-making.<BR><B>BACKGROUND: </B>The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023486294.