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Semin Thromb Hemost 2018; 44(01): 020-029
DOI: 10.1055/s-0037-1606179
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation

James Thomas
1   Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Vadim Kostousov
2   Division of Transfusion Medicine & Coagulation, Department of Pathology & Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
,
Jun Teruya
2   Division of Transfusion Medicine & Coagulation, Department of Pathology & Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
3   Departments of Medicine and Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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Publikationsdatum:
12. September 2017 (online)

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Abstract

Extracorporeal membrane oxygenation (ECMO) has been used for >40 years to support lung and heart failure; however, bleeding and thrombosis remain serious complications. The known etiologies of bleeding include heparin effect or overdose, coagulopathy, thrombocytopenia, platelet dysfunction, acquired von Willebrand syndrome, and hyperfibrinolysis. Bleeding sites may include cannula insertion sites, recent surgical incisions, vascular access sites, lung, gastrointestinal tract, mouth, nose, thoracic cavity, abdominal cavity, and brain. Massive bleeding in the brain, the most feared bleeding complication, can be rapidly fatal because it occurs in a rigid closed space, is difficult to drain, and cannot be stopped with direct pressure to the bleeding site. Pulmonary hemorrhage may cause irreversible lung damage. Management should be swift and precise to prevent fatal bleeding. In contrast, etiologies of thrombosis include high fibrinogen and factor VIII levels, heparin resistance, and platelet activation. Achieving the optimal anticoagulation balance to prevent bleeding and thrombosis in ECMO patients is extremely complex. Experts in hemostasis should be a part of an institutional ECMO team and continuously available for immediate management.

Keywords

extracorporeal membrane oxygenation - ECMO - hyperfibrinolysis - heparin - hemolysis - acquired von Willebrand syndrome - bivalirudin
 

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