Table 3

- Possible causes and management of bleeding on extracorporeal membrane oxygenation (ECMO).

a) Low mean arterial pressure (MAP) with good ECMO flow and NO visible bleeding AND ACT is too highInternal bleedingReduce anticoagulation Investigate source of bleeding
b) Low MAP with good ECMO flow and no visible bleeding AND ACT is within rangeDouble check hemoglobin reading Make sure that patient is not fluid-overloadedTransfuse Fluid removal
c) Low MAP with good ECMO flow and visible bleedingBleeding from wounds or cannula sitesTransfuse Compress Call surgical team
d) Bleeding with low plateletsDestruction of platelets from ECMO Heparin-induced thrombocytopenia (HIT)Transfuse platelets Check for HIT Change anticoagulant
e) Bleeding with normal plateletsFactor deficiency Unstable fibrin clotCheck coagulation Fibrinogen level TEG or ROTEM if available Treat cause
TEG: thromboelastography, ROTEM: rotational thromboelastometry, ACT: activated clotting time