Abstract

Introduction: Extracorporeal Membrane Oxygenation (ECMO) provides temporary mechanical cardiopulmonary support in patients with severe, potentially reversible cardiopulmonary failure. These patients are at risk of bleeding and thrombotic complications depending on the modality and patient-specific factors. Clinical guidelines do not endorse one anticoagulation monitoring assay over another with available evidence recommending use of partial thromboplastin time (PTT), activated clotting time (ACT) or anti–factor Xa levels.  Similarly, a single therapeutic goal is discouraged, as it does not account for interpatient variability.  The purpose of this retrospective chart review was to evaluate hemorrhagic and thrombotic complications among ECMO patients receiving unfractionated heparin infusion.

Methods: This retrospective chart review included data from two hospitals within a large South Florida health system from January 2023 through December 2025. Adults receiving ECMO and systemic anticoagulation for greater than or equal to 24 hours were included. Primary outcomes were incidence of thrombotic and hemorrhagic events. Secondary outcomes included ECMO duration, intensive care unit length of stay, discharge disposition, and percentage of anticoagulation readings within, above, and below goal.

Results: Of 40 patients screened, 20 met inclusion criteria. No thrombotic events were identified. Bleeding occurred in 20% (n = 4) of patients , consisting of two gastrointestinal bleeds and two intracranial hemorrhages at a median of 13 days after ECMO initiation. Three of four patients who bled were thrombocytopenic at the time of the event. Mean time within anticoagulation goal was 51.6% (SD = 17.7), mean ECMO duration was 10 days, mean intensive care unit  length of stay was 18 days and survival to discharge was 40% (n = 8).

Discussion: In this cohort, 20% of the ECMO patients receiving heparin infusion experienced bleeding complications, while no thrombotic events were observed. The results also showed that bleeding risk is associated with prolonged ECMO duration, while PTT levels did not appear to correlate with the bleeds. These findings highlight the complexity of anticoagulation management in ECMO due to inherent hemorrhagic and thrombotic risks. While limited by a small sample, these findings reinforced an institutional decision to expand the ECMO anticoagulation protocol, incorporating multiple goal parameters to better account for interpatient variability in hemorrhagic and thrombotic risk.

Acknowledgment:Claude AI (Anthropic, 2025) was used as needed to provide feedback on flow and sentence clarity.

Publication Date

3-15-2026

Presented At:

Florida Residency Conference

Content Type

Presentation

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