Figure 3.

The management of venous complications induced by ECMO. Deep venous thrombosis is more likely due to systemic inflammatory response and low flow states. Venous injury is induced by the insertion of a catheter and the development of thrombosis due to mechanical thrombosis. Proximal thromboembolism can be performed from the tip of the catheter, while venous hypertension, phlegmasia, and subsequent compartment syndrome can occur when the tissue drains into the catheter site. The use of a venous outflow catheter can reduce venous hypertension. While many venous issues occur at cannulation, they can also occur during decannulation. Venous injury can be considered complicated and uncomplicated. The uncomplicated venous injury can be dealt with by systemic anticoagulation. The complicated venous injury will compromise tissue, and if anticoagulation and systemic optimization fail to lead to improvement in the limb, imaging by duplex or contrast venography should be performed. If imaging shows a thrombotic occlusion, open or percutaneous embolectomy is possible. In the presence of a compartment syndrome, fasciotomy of all compartments should be considered early. NIRS is a vital surveillance mechanism to ensure arterial perfusion is maintained in the presence of an extensive DVT.