Management of anticoagulation and hemostasis for pediatric extracorporeal membrane oxygenation

Compared to in situ vascular physiology where pro and anti-hemostatic processes are in balance to maintain hemostasis, the use of ECMO in a critically ill child increases the risk of hemorrhagic or thromboembolic events due to a perturbation in the balance inherent of this complex system. The ECMO circuit has pro-hemostatic effects due to contact activation of hemostasis and inflammatory pathways. In addition, the critical illness of the child can cause dysregulation of hemostasis that may shift between hyper and hypocoagulable states over time.