Ginga Suzuki, Kohei Ishikawa, Saria Nishioka, Toshimitsu Kobori, Yuka Masuyama, Saki Yamamoto, Hibiki Serizawa, Yoshimi Nakamichi, Mitsuru Honda, Japan Chest CT for acute respiratory distress syndrome requiring venovenous extracorporeal membrane oxygenation (J-CARVE) Registry group
OBJECTIVE: To evaluate whether systemic anticoagulation therapy affects the survival of adult patients receiving venovenous extracorporeal membrane oxygenation (VV-ECMO) for acute respiratory distress syndrome (ARDS). DESIGN: Multicenter retrospective study. SETTING: Twenty-four ICUs in Japan. PATIENTS: Six hundred and ninety-five patients received VV-ECMO for ARDS. Patients were divided into the anticoagulation group and the no-anticoagulation group according to whether or not they received anticoagulant therapy. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In the propensity score-overlap-weighted analysis, there was no significant difference in the 28-day survival (85.8% vs. 81.5%, p = 0.50) between the two groups. The 60-day survival, ECMO duration, circuit exchanges, bleeding complications, and transfusion volumes were also comparable. The anticoagulation group had a significantly higher average activated partial thromboplastin time during ECMO (51.3 s vs. 39.3 s, p < 0.01). These findings remained consistent in the sensitivity analysis using inverse probability of treatment weighting. CONCLUSIONS: Systemic anticoagulation was not associated with short-term survival. Anticoagulation-free VV-ECMO may be feasible in patients at high-bleeding risk, but safety remains uncertain. Further studies should clarify optimal anticoagulation strategies.