Bleeding Associated with ECMO

Extracorporeal membrane oxygenation (ECMO) has been used for approximately 40 years to support the lung and heart; however, bleeding remains a serious complication during ECMO. The known etiology of bleeding includes heparin effect or overdose, coagulopathy, thrombocytopenia, platelet dysfunction, acquired von Willebrand syndrome, and hyperfibrinolysis. Bleeding sites may be cannula insertion sites, the lung, gastrointestinal tract, mouth, nose, thoracic cavity, abdominal cavity, and brain. Among them massive bleeding in the brain can be immediately fatal due to anticoagulation. Pulmonary hemorrhage may cause irreversible lung damage. Management should not be delayed in order to prevent fatal bleeding. However, the balance between bleeding and thrombosis is extremely delicate in the setting of ECMO. Experts in hemostasis should be a part of ECMO team and always available for immediate management.