Anticoagulation and Coagulation Management for ECMO

Since the inception of extracorporeal mem-brane oxygenation (ECMO) in 1971,1 thou-sands of adults and pediatric patients have been saved. Advances in ECMO have reduced mor-bidity and mortality compared with early experi-ences. However, mortality is still high with survival rates of 77 % for neonatal respiratory failure, 53 % for adult respiratory failure, 45 % for pediatric cardiac failure, and 32 % for adult cardiac failure.2 The prin-cipal causes of mortality and morbidity remain bleeding and thrombosis.3,4 Bleeding and thrombo-sis are related to contact of blood and its cellular components with the nonbiologic surface of the extracorporeal circuit (EC) used during ECMO that results in a massive inflammatory and clotting response. Consequently, anticoagulation is neces-sary to prevent thrombosis but it also increases th