Activated clotting time test alone is inadequate to optimize therapeutic heparin dosage adjustment during post-cardiopulmonary resuscitational extracorporeal membrane oxygenation (e-CPR).
BACKGROUND
We conducted an observational study to evaluate the relationship between activated clotting time (ACT) and activated partial thromboplastin time (aPTT) tests, anticipating the possibility that the ACT will become a substitute test for the aPTT in post-CPR extracorporeal membrane oxygenation (e-CPR).


METHODS
Three hundred and fifteen paired ACT and aPTT samples were derived from 60 in-hospital e-CPR patients and were divided into three groups according to the observed ACT value: low level (ACT < 170 s, Group A), intended target level (ACT 170-210 s Group B) and high level (ACT > 210 s, Group C). The relationship of aPTT in each group was analyzed.


RESULTS
The mean ACT and aPTT values were 189.39 ± 48.27 s (IQR, 163-202) and 71.85 ± 45.32 s (IQR, 44.5-81.8), respectively. Although the observed mean ACT value of 189.39 s was similar to the intended mean target value of 190 s (p = 0.823), the observed mean aPTT value (71.85 s) was significantly lower than the predicted mean target value (77.5 s, p = 0.027). Despite the mean ACT values being significantly different in each group (p < 0.0001), the mean aPTT values were not statistically different between Groups A and B (p = 0.317). Of the Group B samples (n = 139), only 31 samples (22.3%) met the optimal therapeutic aPTT range. Pearson's correlation coefficient for Group B showed only a weak correlation between ACT and aPTT (r = 0.177; p = 0.037).


CONCLUSIONS
Our study demonstrates that the ACT test alone does not seem to be enough to optimize therapeutic heparin dosage adjustment during e-CPR.
Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital, Jeju, S. Korea kilsooyie@gmail.com.
Kilsoo
K
Yie
Department of Thoracic and Cardiovascular Surgery, Cheju Halla General Hospital, Jeju, S. Korea.
Soon-Ho Daniel
SH
Chon
Department of Thoracic and Cardiovascular Surgery, Keimyung University, College of Medicine, Daegu, S.Korea.
Chan-Young
CY
Na
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D014914:Whole Blood Coagulation Time
D006493:Heparin
ACT; CPR; ECMO; PCPS; aPTT; anticoagulation; e-CPR