体外膜肺氧合患者抗凝及出血风险管理的最佳证据总结

Summary of the best evidence for anticoagulation and bleeding risk management in patients with extracorporeal membrane oxygenation

目的评价和总结体外膜肺氧合(ECMO)患者抗凝及出血风险管理的相关证据,为临床医护人员提供ECMO治疗期间抗凝及出血管理的循证依据.方法依照证据"6S"金字塔模型系统检索国内外相关数据库、组织、指南网站中有关ECMO技术抗凝管理及出血风险的所有证据,证据类型包括指南、专家共识、系统评价、Meta分析和原始研究,检索时限为2012年5月31日至2022年5月31日.由2名有循证研究背景的研究者对检索到的证据进行独立的文献质量评价,结合业内专家意见,对符合质量标准的文献进行证据提取及总结.结果初步检索共获得文献315篇,最终纳入13篇文献,包括3篇指南、6篇专家共识和4篇Meta分析.从ECMO抗凝剂的选择、预充中的抗凝、运行中的抗凝、抗凝监测、出血及治疗、血栓及治疗、肢体末端缺血的预防和处理7个方面汇总27条最佳证据.结论该证据总结为临床医护人员提供了ECMO患者抗凝管理及出血预防的循证依据,建议在评估所在医疗机构的临床环境条件后选择性应用最佳证据,以改善ECMO患者预后.

Objective To evaluate and summarize the relevant evidence of anticoagulation and bleeding risk management in patients with extracorporeal membrane oxygenation(ECMO),and provide the evidence-based basis for the management of anticoagulation and bleeding during ECMO treatment.Methods According to the evidence"6S"pyramid model,all evidence on ECMO anticoagulation management and bleeding risk was searched in relevant databases,organizations and guideline websites at home and abroad.Evidence types included guidelines,expert consensus,systematic evaluation,Meta-analysis and original study.The search time limit was from May 31,2012 to May 31,2022.Two researchers with evidence-based research background conducted independent literature quality evaluation of the retrieved evidence,and the evidence that met the quality standards was extracted and summarized based on the opinions of industry experts.Results A total of 315 articles were retrieved,and 13 articles were included,including 3 guidelines,6 expert consensus,and 4 Meta-analysis.A total of 27 best evidences were summarized from 7 aspects,including the selection of ECMO anticoagulation,anticoagulation in priming,anticoagulation in operation,anticoagulation monitoring,bleeding and treatment,thrombosis and treatment,and prevention and management of terminal limb ischemia.Conclusions This study provides evidence-based basis for bleeding prevention and anticoagulant management in ECMO patients.It is recommended to selectively apply the best evidence after evaluating the clinical environmental conditions of medical institutions,so as to improve the prognosis of ECMO patients.