ECMO and anticoagulation: A comprehensive review

Since the last decade extracorporeal membrane oxygenation (ECMO) therapy has been widely accepted as the treatment of life-threatening cardiac and pulmonary failure. Maintaining homeostasis of the haemostatic system remains a major challenge. The choice of anticoagulants to inhibit continuous activation of coagulation by the non-endothelialised systems is still restricted. The most widely used agent is intravenous unfractionated heparin. Although one might expect monitoring of the anticoagulant level to be straightforward, the number of bleeding or thrombotic complications is still too high. In this review, we report the impact of an extracorporeal circuit on the coagulation system and its complications. We describe the strategies for anticoagulation and possibilities of monitoring their effects. Finally, we give a view of the future developments in this specific field.