• Zhen Guo, Lin Sun, Bailing Li, Rui Tian, Xiaolin Zhang, Zhongwei Zhang, Sean P Clifford, Yuan Liu, Jiapeng Huang, and Xin Li.
• Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
• J. Cardiothorac. Vasc. Anesth. 2021 Feb 1; 35 (2): 389-397.

ObjectiveTo explore special coagulation characteristics and anticoagulation management in extracorporeal membrane oxygenation (ECMO)-assisted patients with coronavirus disease 2019 (COVID-19).DesignSingle-center, retrospective observation of a series of patients.ParticipantsLaboratory-confirmed severe COVID-19 patients who received venovenous ECMO support from January 20-May 20, 2020.InterventionsThis study analyzed the anticoagulation management and monitoring strategies, bleeding complications, and thrombotic events during ECMO support.Measurements And Main ResultsEight of 667 confirmed COVID-19 patients received venovenous ECMO and had an elevated D-dimer level before and during ECMO support. An ECMO circuit pack (oxygenator and tubing) was replaced a total of 13 times in all 8 patients, and coagulation-related complications included oxygenator thrombosis (7/8), tracheal hemorrhage (5/8), oronasal hemorrhage (3/8), thoracic hemorrhage (3/8), bleeding at puncture sites (4/8), and cannulation site hemorrhage (2/8).ConclusionsHypercoagulability and secondary hyperfibrinolysis during ECMO support in COVID-19 patients are common and possibly increase the propensity for thrombotic events and failure of the oxygenator. Currently, there is not enough evidence to support a more aggressive anticoagulation strategy.Copyright © 2020 Elsevier Inc. All rights reserved.

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