Anticoagulation Management in Severe Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation

Objective

To explore special coagulation characteristics and anticoagulation management in extracorporeal membrane oxygenation (ECMO)–assisted patients with coronavirus disease 2019 (COVID-19).

Design

Single-center, retrospective observation of a series of patients.

Participants

Laboratory-confirmed severe COVID-19 patients who received venovenous ECMO support from January 20–May 20, 2020.

Interventions

This study analyzed the anticoagulation management and monitoring strategies, bleeding complications, and thrombotic events during ECMO support.

Measurements and Main Results

Eight 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).

Conclusions

Hypercoagulability 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.