ICU · Respiratory / ventilation

ECMO Complications — Clotting, Haemolysis, Infection, Neurological

Also known as ECMO complications · ECMO bleeding · Circuit thrombosis · ECMO haemolysis · ECMO infection · ECMO neurological complications · ECMO stroke · Heparin-induced thrombocytopenia · HIT · Plasma-free haemoglobin · Harlequin syndrome · North-south syndrome · Distal perfusion cannula · Pump thrombosis

ECMO is a high-risk therapy whose complications fall into four categories. Clotting: bleeding is the commonest serious complication (anticoagulation plus large cannulae; intracranial haemorrhage the most feared), balanced against circuit thrombosis from under-anticoagulation. Haemolysis: from pump shear, kinked cannulae, or an oxygenator clot — a rising plasma-free haemoglobin, falling haptoglobin, dark urine, hyperkalaemia, and haemoglobinuric AKI. Infection: cannula-site, bloodstream, and nosocomial. Neurological: ischaemic and haemorrhagic stroke and intracranial haemorrhage, plus the hypoxic brain injury of ECPR. Anticoagulate to the lowest effective target; monitor the circuit pressures, the free haemoglobin, the cultures, and have a low threshold for a CT for any neurological change.