초록접수 현황
| 20F-010 | 구연 발표 |
Satisfactory Outcome with Low Activated Clotting Time (<160 seconds) in Extracorporeal Cardiopulmonary Resuscitation
Hong Ju Shin, Jeong In Hong, Jinwook Hwang, Jae Seung Shin
Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Ansan, Korea
Purpose : High mortality rate of extracorporeal Cardiopulmonary Resuscitation (ECPR) is commonly due to bleeding and thromboembolism. In this study, we aimed to show that maintaining lower target ACT (activated clotting time) level (<160 s) does not affect the mortality and complication rates.
Methods : This is a single-centered retrospective study, reviewing the medical records of 81 adult patients that were on ECMO support from March 2017 to March 2020. Of these patients, 51 patients were preceded by cardiopulmonary resuscitation. This is a comparison study between low versus conventional ACT maintenance groups. Bleeding or thromboembolic events were investigated as primary outcomes. Secondary outcome was ECMO weaning and survival to discharge rate.
Results : 32 patients were included and divided into low (n = 14) and conventional (n = 18) ACT groups. There was no significant difference in thrombosis and bleeding between two groups. There was significant difference in successful weaning rate (92.9 % vs. 50.0%, p = 0.019). There were 4 cases of bleeding or thromboembolic events in low ACT group and 1 case of prolonged cannulation site bleeding was seen in conventional ACT group. One patient did not require any anticoagulation therapy in maintaining ACT above 160 seconds.
Conclusion : Maintaining a lower than conventional ACT level in patients requiring ECMO support post CPR did not result in significant increase of bleeding or thromboembolic risk. Thus, targeting to a lower ACT level may be considered in this particular group of patients. Further studies and trials are needed to establish a guideline for anticoagulation monitoring.
Methods : This is a single-centered retrospective study, reviewing the medical records of 81 adult patients that were on ECMO support from March 2017 to March 2020. Of these patients, 51 patients were preceded by cardiopulmonary resuscitation. This is a comparison study between low versus conventional ACT maintenance groups. Bleeding or thromboembolic events were investigated as primary outcomes. Secondary outcome was ECMO weaning and survival to discharge rate.
Results : 32 patients were included and divided into low (n = 14) and conventional (n = 18) ACT groups. There was no significant difference in thrombosis and bleeding between two groups. There was significant difference in successful weaning rate (92.9 % vs. 50.0%, p = 0.019). There were 4 cases of bleeding or thromboembolic events in low ACT group and 1 case of prolonged cannulation site bleeding was seen in conventional ACT group. One patient did not require any anticoagulation therapy in maintaining ACT above 160 seconds.
Conclusion : Maintaining a lower than conventional ACT level in patients requiring ECMO support post CPR did not result in significant increase of bleeding or thromboembolic risk. Thus, targeting to a lower ACT level may be considered in this particular group of patients. Further studies and trials are needed to establish a guideline for anticoagulation monitoring.
책임저자: Hong Ju Shin
Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
발표자: Hong Ju Shin, E-mail : babymedi@naver.com