title: Successful management of bleeding complications in patients supported with extracorporeal membrane oxygenation with primary respiratory failure.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) is a lifesaving procedure in patients with severe respiratory insufficiency failing conventional support. Bleeding complications are common due to the necessity for anticoagulation and circuit-related factors.
  
  
  METHODS
  A retrospective review was conducted in patients requiring ECMO for respiratory failure from 7/2010 to 6/2011 to identify episodes of major bleeding, bleeding management and outcomes.
  
  
  RESULTS
  Twenty-one patients were supported with ECMO during the study although five experienced massive bleeding related to chest tube insertion, jejunal arterio-venous malformations, distal perfusion cannula dislodgement and ventricular rupture. Patients required aggressive resuscitation or endoscopic or operative intervention, totaling 28 procedures. There were no instances of dehiscence, infection or sepsis related to interventions. Anticoagulation was stopped six hours before and restarted 24 hours after major interventions, with no thrombotic or neurologic complications. All patients weaned off ECMO were discharged.
  
  
  CONCLUSIONS
  ECMO bleeding complications can be managed successfully via surgical and endoscopic approaches in this high-risk population.
authors.affiliation: Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Lamb
authors.forename: S W
authors.initials: SW
authors.lastname: Cowan
authors.forename: N
authors.initials: N
authors.lastname: Evans
authors.forename: H
authors.initials: H
authors.lastname: Pitcher
authors.forename: T
authors.initials: T
authors.lastname: Moritz
authors.forename: M
authors.initials: M
authors.lastname: Lazar
authors.forename: H
authors.initials: H
authors.lastname: Hirose
authors.forename: N C
authors.initials: NC
authors.lastname: Cavarocchi
mesh_terms: D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000601:surgery; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000601:surgery*