A best evidence summary of anticoagulation management for extracorporeal membrane oxygenation in adults

This study aims to synthesize the highest quality evidence for the anticoagulation management of extracorporeal membrane oxygenation (ECMO) in adults, providing an evidence-based foundation for clinical practice in ECMO anticoagulation.

An evidence summary approach was employed, adhering to the evidence summary reporting standards established by the Evidence-Based Nursing Center of Fudan University. Utilizing the "6S" evidence hierarchy model, comprehensive searches were conducted across both domestic and international databases for evidence pertaining to anticoagulation in ECMO patients. The literature types encompassed guidelines, expert consensus statements, best practices, and systematic reviews. The search period extended from January 1, 2019, to May 31, 2024. Two evidence-based reviewers independently extracted and synthesized relevant data from qualifying literature.

The initial search yielded 553 articles, from which 10 were selected following rigorous screening. These comprised 3 clinical guidelines, 3 clinical decisions, 2 systematic reviews, and 2 expert consensus articles. In total, 30 best evidence statements were distilled, categorized into pre-anticoagulation evaluation, individualized anticoagulation strategies, complication prevention and treatment, and nursing care. Among these, 25 were strong recommendations, 5 were weak recommendations, and 14 were secondary evidence.

The study identified 30 best evidence statements for anticoagulation management in adult ECMO. Given the diverse origins of these evidence statements, clinical practitioners must consider contextual factors such as specific clinical settings and patient conditions prior to application. Future research should focus on the clinical application of this evidence summary to foster evidence implementation and to develop standardized clinical nursing protocols.