Background. Major bleeding has been a common and serious complication with poor outcomes in ECMO patients. With a novel, less-invasive cannulation approach and closer coagulation monitoring regime, the incidence of major bleeding is currently not determined yet. Our study aims to examine the incidence of major bleeding, its determinants, and association with mortality in peripheral-ECMO patients. Method. We conducted a single-center retrospective study on adult patients undergoing peripheral-ECMO between January 2019 and January 2020 at a tertiary referral hospital. Determinants of major bleeding were defined by logistic regression analysis. Risk factors of in-hospital mortality were determined by Cox proportional hazard regression analysis. Results. Major bleeding was reported in 33/105 patients (31.4%) and was associated with higher in-hospital mortality [adjusted hazard ratio (aHR) 3.56, 95% confidence interval (CI) 1.63–7.80, ). There were no significant difference in age, sex, ECMO indications, ECMO modality, pre-ECMO APACHE-II and SOFA scores between two groups with and without major bleeding. Only APTT >72 seconds [adjusted odds ratio (aOR) 7.10, 95% CI 2.60–19.50, ], fibrinogen <2 g/L [aOR = 7.10, 95% CI 2.60–19.50, ], and ACT >220 seconds [aOR = 3.9, 95% CI 1.20–11.80, ] on days with major bleeding were independent predictors. Conclusions. In summary, major bleeding still had a fairly high incidence and poor outcome in peripheral-ECMO patients. APTT > 72 seconds, fibrinogen < 2 g/L were the strongest predicting factors for major bleeding events.

Background: Hemostatic dysfunction during extracorporeal membrane oxygenation (ECMO) due to blood-circuit interaction and the consequences of shear stress imposed by flow rates lead to rapid coagulation cascade and thrombus formation in the ECMO system and blood vessels. We aimed to identify the incidence and risk factors for cannula-associated arterial thrombosis (CaAT) post-decannulation. Methods: A retrospective study of patients undergoing arterial cannula removal following ECMO was performed. We evaluated the incidence of CaAT and compared the characteristics, ECMO machine parameters, cannula sizes, number of blood products transfused during ECMO, and daily hemostasis parameters in patients with and without CaAT. Multivariate analysis identified the risk factors for CaAT. Results: Forty-seven patients requiring venoarterial ECMO (VA-ECMO) or hybrid methods were recruited for thrombosis screening. The median Sequential Organ Failure Assessment score was 11 (interquartile range, 8–13). CaAT occurred in 29 patients (61.7%), with thrombosis in the superficial femoral artery accounting for 51.7% of cases. The rate of limb ischemia complications in the CaAT group was 17.2%. Multivariate analysis determined that the ECMO flow rate–body surface area (BSA) ratio (100 ml/min/m2) was an independent factor for CaAT, with an odds ratio of 0.79 (95% confidence interval, 0.66–0.95, P=0.014). Conclusions: We found that the incidence of CaAT was 61.7% following successful decannulation from VA-ECMO or hybrid modes, and the ECMO flow rate–BSA ratio was an independent risk factor for CaAT. We suggest screening for arterial thrombosis following VA-ECMO, and further research is needed to determine the risks and benefits of such screening.

Background: Transporting patients on extracorporeal membrane oxygenation (ECMO) is a standard practice in high-resource settings but remains limited in low- and middle-income countries due to financial, infrastructural, and staffing constraints. This study evaluated the safety, complications, and outcomes of ECMO transport in a low-resource setting. Methods: This retrospective study conducted ECMO transport at a tertiary hospital in Ho Chi Minh City, Vietnam, from January 2019 to January 2023. Data on demographics, transport logistics, ECMO configuration, complications, and clinical outcomes were analyzed, including subgroup comparisons between COVID-19 and non-COVID-19 patients. Results: Thirty-nine patients (mean age 45 years; 56.4% female) underwent inter-hospital ECMO transport over a median distance of 7.9 km. All patients survived transport, although one patient (2.6%) had a mechanical complication. Other complications recorded during ECMO support included infection in 53.8%, major bleeding in 23.1%, and pneumothorax in 5.1%. Overall survival to discharge was 69.2%. COVID-19 patients had a significantly lower discharge survival than non-COVID-19 patients (42.9% vs. 81.8%, p = 0.029) Conclusion: ECMO transport can be safely implemented in low-resource settings, achieving outcomes comparable to in-house ECMO support. Further research is essential to develop standardized protocols and expand ECMO networks to improve patient outcomes in resource-limited settings.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a form of extracorporeal circulation that provides cardiopulmonary support in cardiogenic shock unresponsive to conventional therapy. Historically, VA-ECMO was limited to the operating room and primarily used to manage postcardiotomy cardiogenic shock cases. However, with advances in ECMO technology and a better understanding of patient selection criteria, VA-ECMO has expanded its role as a temporary and adaptable intervention in cardiogenic shock of diverse etiologies. This review provides an updated overview of the indications for peripheral VA-ECMO, discussing how recent studies have enhanced our understanding of when VA-ECMO should be considered. In addition, we discuss the feasibility of surgery during VA-ECMO support to improve perioperative planning and tailored anesthetic strategies following ECMO-related physiologic and pharmacological changes.

Background Regional citrate anticoagulation has advantages over systemic heparin in prolonging filter life and decreasing bleeding risk during continuous renal replacement therapy (CRRT). However, implementing regional citrate anticoagulation in resource-limited intensive care units (ICU) remains challenging due to potential adverse events and the absence of standardized protocols. This study aims to evaluate the efficacy and safety of regional citrate anticoagulation in CRRT for critically ill patients in low-resource settings. Methods This single-center, prospective cohort study enrolled critically ill patients with acute kidney injury (AKI) requiring CRRT at a resource-limited ICU in Vietnam. Patients received either regional citrate anticoagulation or heparin anticoagulation. Primary outcomes included filter lifespan and adverse events; secondary outcomes were renal recovery and in-hospital mortality rate. Results One hundred twenty-one patients were enrolled, 42 in the citrate group and 79 in the heparin group. The citrate group had a significantly longer filter lifespan (median 56 h versus 31 h; p < 0.001) and a lower rate of premature (< 24 h) filter clotting (4.8% versus 27.2%, p < 0.001). The hemorrhage rate was 6.4% in the citrate group versus 12.9% in the heparin group (p = 0.162). However, hypomagnesemia occurred more frequently in the citrate group (58.7% versus 23.1%, p < 0.001). No significant differences in renal recovery or hospital mortality were observed between groups. Conclusion Regional citrate anticoagulation effectively maintained filter patency and proved to be safe for CRRT in a resource-limited ICU. Further studies are needed to establish standardized protocols for regional citrate anticoagulation in this setting to minimize citrate-related adverse events. Graphical abstract