Table 1.
Characteristics of included studies
| Author | Year of publication | Study design | Type of Comparison | Number of participants per group | Adult / pediatric patients | Type of ECMO | Indication for ECMO | Male sex | Mean age ± SD (years) | aPTT aim (s) |
|---|---|---|---|---|---|---|---|---|---|---|
| Hamzah [63] |
2022 (under review) |
Multi center, retrospective | Heparin vs. Bivalirudin |
Total: 225 Hep.: 150 Biv.: 75 |
pediatric |
VV-ECMO: 36 VA-ECMO: 141 eCPR: 48 |
eCPR: 48 CPB weaning: 115 Not reported: 62 |
Hep.: 74 Biv.: 38 |
Hep.: 8 (1, 36) Biv.: 7 (2, 37) (months, median, IQR) |
Not reported |
| Pieri [58] | 2021 | Single center, retrospective | Heparin vs. Bivalirudin |
Total: 125 Hep.: 26 Biv.: 99 |
All adult patients | VV-ECMO only | ARDS only | Total: 93 | Not reported |
Hep.: 55–60 Biv.:55–60 |
| Sheridan [9] | 2021 | Single center, retrospective | Heparin vs. Bivalirudin |
Total: 150 Hep.: 50 Biv.: 100 |
All adult patients |
VV-ECMO: 52 VA-ECMO: 88 |
CS: 58 Resp. fail.: 59 PE: 10 CPB weaning: 11 Others:12 |
Total: 106 Hep.: 32 Biv.: 74 |
Total: 53 ± 14.5 Hep.: 53 ± 14 Biv.: 54 ± 15 |
Hep.: < 95 and anti-FXa 0.3–0.7 IU/mL Biv.:45–75 |
| Machado [54] | 2021 | Single center, retrospective | Heparin vs. Bivalirudin |
Total: 32 Hep.: 14 Biv.: 18 |
All pediatric patients |
VA-ECMO: 30 VV-ECMO: 1 Hybrid: 1 |
Not reported |
Total: 12 Hep.: 9 Biv.: 7 |
Hep.: 39.8 ± 76.1 Biv.: 36 ± 58.8 (months) |
Not reported (individual goals) |
| Seelhammer [62] | 2021 | Single center, retrospective | Heparin vs. Bivalirudin |
Total: 422 Hep.: 288 Biv.: 134 |
Adult: 333 Pediatric: 89 |
VA-ECMO: 358 VV-ECMO: 64 |
Post cardiotomy: 162 CS: 100 Resp. fail.: 86 eCPR: 69 Transplant: 5 |
Total: 265 Hep.: 183 Biv.: 82 |
Not reported |
Hep.: 60–90 Biv.: 60–80 |
| Schill [63] | 2021 | Single center, retrospective |
Heparin vs. Bivalirudin vs. switched |
Total: 54 Hep.: 34 Biv.: 14 Switched: 8 |
All pediatric patients |
VA-ECMO: 38 VV-ECMO: 18 |
Post cardiotomy: 20 Resp. fail.: 19 CS: 17 |
Not reported |
Hep.: 16.3 (4.8, 143.7) Biv.: 5.5 (3.7, 79.6) (months, median,IQR) |
Hep.: anti-FXa 0.3–0.7 IU/mL Biv.: 60–95 |
| Kaushik [52] | 2021 | Single center, retrospective | Heparin vs. Bivalirudin vs. switched |
Total: 39 Hep.: 27 Biv.: 8 Switched: 4 |
All pediatric patients |
VA-ECMO:34 VV-ECMO: 4 Hybrid: 1 |
Resp. Fail.: 12 CS: 11 eCPR: 6 |
Total: 20 Hep.: 15 Biv.: 3 |
Hep.: 4.0 (0.5, 92.0) Biv.: 0.6 (0.0, 80.0) (months, median, IQR) |
Hep.: 60–90 Biv.: 60–90 |
| Rivosecchi [60] | 2021 | Single center, retrospective | Heparin vs. Bivalirudin |
Total: 295 Hep.: 162 Biv.: 133 |
All adult patients | VV-ECMO only |
Resp. fail.: 145 Pre/post-transplant: 108 Post cardiotomy: 20 Others: 22 |
Total: 146 Hep.: 95 Biv.: 81 |
Hep.: 49 (36,61) Biv.: 49 (36,61) (median, IQR) |
Hep.: anti-FXa 0.25–0.35 IU/mL Biv.: 60–75 |
| Fisser [10] | 2021 | Single center, retrospective | Heparin vs. Argatroban |
Total: 117 Hep.: 78 Arg.: 39 |
All adult patients | VV-ECMO only | ARDS only |
Total: 80 Hep.: 51 Arg.: 29 |
Hep.: 56 (48,63) Arg.: 55 (46,61) (median, IQR) |
Hep.: 45–55 Arg.:45–55 |
| Cho [50] | 2021 | Single center, retrospective | Heparin vs. Argatroban |
Total: 35 Hep.: 24 Arg.: 11 |
All adult patients |
VA-ECMO: 10 VV-ECMO: 21 Hybrid: 4 |
Not reported |
Total: 22 Hep.: 15 Arg.: 7 |
Total: 46 ± 17 Hep.: 45 ± 16 Arg.: 49 ± 20 |
Hep.: 40–60 or 60–80 (high dose) Arg.:43–85 |
| Hamzah [11] | 2020 | Single center, retrospective | Heparin vs. Bivalirudin |
Total: 32 Hep.: 16 Biv.: 16 |
All pediatric patients |
VA-ECMO: 29 VV-ECMO: 3 |
Post cardiotomy:13 Others: not reported |
Total: 14 Hep.: 8 Biv.: 6 |
Total: 12 (0–212) Hep.: 59 (0, 212) Biv.: 31 (0–99) (months, median, IQR) |
Hep.: 60–80 Biv.: 58–78 or 50–70 (open chest) |
| Kaseer [51] | 2020 | Single center, retrospective | Heparin vs. Bivalirudin |
Total: 52 Hep.: 33 Biv.: 19 |
All adult patients |
VA-ECMO: 28 VV-ECMO: 24 |
CS:15 ARDS:24 Transplant: 17 Others:1 |
Total: 37 Hep.: 25 Biv.: 12 |
Total: 55 (18, 83) Hep.: 53 (21, 83) Biv.: 56 (18, 71) (median, IQR) |
Hep.: 50–70 or 40–60 Biv.: 60–90 or 50–70 |
| Macielak [55] | 2019 | Single center, retrospective | Heparin vs. Bivalirudin vs. switched |
Total: 153 Hep.: 100 Biv.: 10 Switched: 43 |
All adult patients |
VA-ECMO: 134 Other types not reported |
Salvage: 61% CS: 46% ARDS:29% Resp. fail.: 29% CPB weaning: 23% Others: 12% |
Total: 127 |
Total: 52.8 ± 14.2 Hep.: 51.4 ± 14.0 Biv.: 57.9 ± 13.8 |
Hep.: 72–95 Biv.: 60–80 |
| Berei [49] | 2018 | Single center, retrospective | Heparin vs. Bivalirudin |
Total: 72 Hep.: 28 Biv.: 44 |
All adult patients |
VA-ECMO: 66 VV-ECMO: 6 |
CS: 51 Sepsis: 11 Resp. fail.: 4 Others: 6 |
Total: 47 Hep.: 18 Biv.: 29 |
Hep.: 55.9 ± 13.1 Biv.: 55.2 ± 15.2 |
Hep.: 45–65 or 65–90 Biv.: 45–65 or 65–90 |
| Menk [56] | 2017 | Single center, retrospective | Heparin vs. Argatroban |
Total: 78 Hep.: 39 Arg.: 39 |
All adult patients |
VV-ECMO: 43 pECLA: 24 Hybrid: 11 |
ARDS only |
Total: 54 Hep.: 27 Arg.: 27 |
Hep.: 48 (35,64) Arg.: 47 (36,60) (median, IQR) |
Hep.: 50–75 Arg.:50–75 |
| Ljajikj [53] | 2017 | Single center, retrospective | Heparin vs. Bivalirudin |
Total: 20 Hep.: 10 Biv.: 10 (after PS-Matching) |
All adult patients | VA-ECMO only | support pre, during and after LVAD implantation only |
Total: 17 Hep.: 9 Biv.: 8 |
Hep.: 52.5 ± 9.7 Biv.: 48.2 ± 14.1 |
Not reported |
| Pieri [57] | 2013 | Single center, retrospective | Heparin vs. Bivalirudin |
Total: 20 Hep.: 10 Biv.: 10 |
All adult patients |
VA-ECMO: 10 VV-ECMO: 10 |
Not reported |
Total: 16 Hep.: 9 Biv.: 7 |
Hep.: 54 ± 12.7 Biv.: 59.5 ± 14.4 |
Hep.: 45–60 Biv.: 45–60 |
| Ranucci [59] | 2011 | Single center, retrospective | Heparin vs. Bivalirudin |
Total: 21 Hep.: 8 Biv.: 13 |
Adult: 12 Pediatric: 9 |
VVA-ECMO: 21 | Post cardiotomy only | Not reported |
Hep.: 13.9 ± 19 Biv.: 36.5 ± 29 |
Hep.: 50–80 Biv.: 50–80 |
ARDS acute respiratory distress syndrome, Arg Argatroban, Biv Bivalirudin, CPB cardiopulmonary bypass, CS cardiogenic shock, eCPR extracorporeal cardio pulmonary resuscitation, Hep Heparin, IQR interquartile range, PE pulmonary embolism, Resp. Fail. respiratory failure, VA-ECMO venoarterial extracorporeal membrane oxygenation, VV-ECMO venovenous extracorporeal membrane oxygenation