Table 3.

- Possible causes and management of bleeding on extracorporeal membrane oxygenation (ECMO).

Cause	Cause	Solution
a) Low mean arterial pressure (MAP) with good ECMO flow and NO visible bleeding AND ACT is too high	Internal bleeding	Reduce anticoagulation Investigate source of bleeding
b) Low MAP with good ECMO flow and no visible bleeding AND ACT is within range	Double check hemoglobin reading Make sure that patient is not fluid-overloaded	Transfuse Fluid removal
c) Low MAP with good ECMO flow and visible bleeding	Bleeding from wounds or cannula sites	Transfuse Compress Call surgical team
d) Bleeding with low platelets	Destruction of platelets from ECMO Heparin-induced thrombocytopenia (HIT)	Transfuse platelets Check for HIT Change anticoagulant
e) Bleeding with normal platelets	Factor deficiency Unstable fibrin clot	Check coagulation Fibrinogen level TEG or ROTEM if available Treat cause
TEG: thromboelastography, ROTEM: rotational thromboelastometry, ACT: activated clotting time