ECMO complications

Neurologic	Hematologic
Intracranial bleeding^* Thromboembolic stroke Seizures (due to intracranial pathology)	Hemorrhage^* (cannula site, surgical site, GIB, pulmonary, CNS, RP) Hemolysis^* Disseminated intravascular coagulation DVT and thromboembolism (systemic, cardiac, or pulmonary)^* Thrombocytopenia (including HIT) Retroperitoneal hematoma
Pulmonary	Device-related
Pulmonary hemorrhage^* Pulmonary embolism Pulmonary edema	Cannula-related Cannula misplacement Vessel perforation Cannula site bleeding^* and infection Limb ischemia Compartment syndrome Cannula thrombosis	Circuit-related Thrombosis^* Oxygenator failure^* Air embolism Pump failure Hypothermia Altered pharmacokinetics (drug sequestration, altered volume of distribution) Recirculation
Cardiac	Renal
Arrythmias (atrial or ventricular)^* Cardiac perforation Pericardial tamponade Congestive heart failure Ventricular distension Intracardiac thrombosis	Acute kidney injury
Infections
Cannula insertion site Blood stream infection/bacteremia^*

Most of these complications are applicable to V-V ECMO, V-A ECMO, and ECCO₂R. However, the proportions of specific complications may be different among these modes. For example, arterial thromboembolism causing stroke and neurologic injury, pulmonary hemorrhage from poor left ventricular emptying, limb ischemia, and coronary or cerebral hypoxia are more likely to occur in patients receiving V-A ECMO while recirculation can only occur in V-V ECMO; the latter is more likely if the patient has a 2-site configuration, rather than single-site.

Some complications not listed on the table may relate to the underling disorder or mechanical ventilation, such as barotrauma.

CNS: central nervous system; DVT: deep venous thrombosis; ECCO₂R: extracorporeal carbon dioxide removal; ECMO: extracorporeal membrane oxygenation; GIB: gastrointestinal bleeding; HIT: heparin-induced thrombocytopenia; RP: retroperitoneal; V-A: venoarterial; V-V: venovenous.

* The asterisk indicates the most common complications, which are mostly due to bleeding or thrombosis and in the region of 3 to 5% in prevalence, some higher (eg, circuit clots, infections, arrythmias).

Graphic 140676 Version 2.0

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ECMO complications