- Possible causes and management of bleeding on extracorporeal membrane oxygenation (ECMO).
| Cause | Cause | Solution |
|---|---|---|
| a) Low mean arterial pressure (MAP) with good ECMO flow and NO visible bleeding AND ACT is too high | Internal bleeding | Reduce anticoagulation Investigate source of bleeding |
| b) Low MAP with good ECMO flow and no visible bleeding AND ACT is within range | Double check hemoglobin reading Make sure that patient is not fluid-overloaded | Transfuse Fluid removal |
| c) Low MAP with good ECMO flow and visible bleeding | Bleeding from wounds or cannula sites | Transfuse Compress Call surgical team |
| d) Bleeding with low platelets | Destruction of platelets from ECMO Heparin-induced thrombocytopenia (HIT) | Transfuse platelets Check for HIT Change anticoagulant |
| e) Bleeding with normal platelets | Factor deficiency Unstable fibrin clot | Check coagulation Fibrinogen level TEG or ROTEM if available Treat cause |
| TEG: thromboelastography, ROTEM: rotational thromboelastometry, ACT: activated clotting time | ||