Management of vascular complications of extra-corporeal membrane oxygenation

The first description of successful extra-corporeal membrane oxygenation (ECMO) was reported by Hill and colleagues in 1972 (1). ECMO was introduced to provide post-operative circulatory support for patients undergoing cardiac surgery. Technological advances and the H1N1 pandemic in 2009 opened the door for wider application of this lifesaving technique (2-4). Currently, it is an established treatment option for patients requiring temporary cardiopulmonary support (5-7). A circulatory bypass is established using large bore vascular cannulas to cycle the blood through an extracorporeal device which performs the physiological role of the heart and lungs. The extracorporeal device consists of a membrane oxygenator and a blood pump. The membrane oxygenator provides an efficient surface for gaseous exchange. The blood pump provides hemodynamic support. A low priming volume and low resistance to blood flow with a thrombosis-resistant coating minimize thrombotic events (8-10). The duration of support is typically 1–3 weeks (11). Patients are maintained on systemic anticoagulation while on ECMO. Vascular complications, both bleeding and thrombosis remain the leading causes of morbidity and mortality in patients treated with ECMO (12,13). This review will focus on the management of vascular complications of ECMO