Extracorporeal membrane oxygenation without systemic anticoagulation: a case-series in challenging conditions

Extracorporeal membrane oxygenation (ECMO) is essential for the treatment of refractory cardiac or pulmonary failure. Its implementation, however, is frequently plunged by bleeding complications, whose rate ranges between 10% and 30% in the ECMO runs (1). Indeed, systemic anticoagulation (SA) although appropriate to enhance uneventful blood/foreign surface contact, avoiding thromboembolic events as well as ECMO system malfunction, is responsible for the majority of the haemorrhagic events and have been representing a contraindication for ECMO application in specific challenging clinical backgrounds (2,3). Haemorrhagic shock, traumatic injuries, and severe active bleedings are only a few of them (4). Sepsis-associated or post-cardiotomy cardiogenic shock are also two relevant pathophysiological conditions, in which haemostatic homeostasis is compromised respectively by infection-related acquired coagulopathy (5) and the effects of systemic heparinization during cardiopulmonary bypass, making ECMO-related anticoagulation a threat for further coagulation disorders and intractable bleeding (6,7)