Complications of ECMO can be patient- or circuit-related. Common circuit-related complications include hemolysis, clotting, cannula-related vascular injury, bleeding due to anticoagulation, and oxygenator dysfunction. Blood clots are the most feared circuit-related complications, and can develop in any part of the ECMO circuit, including the pump, oxygenator, or tubing. Signs of clot formation include rising plasma-free hemoglobin or lactate dehydrogenase, an increasing pressure gradient across the oxygenator, and a fall in post-oxygenator oxygen saturation. Oxygenator dysfunction is often a result of clot formation that reduces gas exchange. Longer-term VV-ECMO will usually require oxygenator changes. Vascular injuries based on cannula location can result in reduced distal tissue perfusion. Most commonly, the risk of distal limb ischemia exists in peripheral femoral arterial cannulation. To prevent ischemia, a distal perfusion catheter is placed in the femoral artery distal to the arterial cannula, to provide antegrade flow to the lower leg.

Patient-related complications include bleeding (cannula site, GI, airway, intracerebral), sepsis, thrombosis, and multiorgan dysfunction.

References

• ELSO Guidelines for Cardiopulmonary Extracorporeal Life Support Extracorporeal Life Support Organization, Version 1.4. Accessed May 14, 2023. www.elso.org
• Lafç G, Budak AB, Yener AÜ, et al. Use of extracorporeal membrane oxygenation in adults. Heart Lung Circ. 2014;23:10-23.
• Rao P, Khalpey Z, Smith R, Burkhoff D, Kociol RD. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail. 2018;11:e004905.