• Asad Ali Usman, Jason Han, Andrew Acker, Salim E Olia, Christian Bermudez, Brett Cucchiara, Mark E Mikkelsen, Joyce Wald, Emily Mackay, Wilson Szeto, William J Vernick, and Jacob T Gutsche.
• Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA.
• J. Cardiothorac. Vasc. Anesth. 2020 Nov 1; 34 (11): 300630123006-3012.

ObjectiveAnticoagulation may be a challenge in coronavirus disease 2019 (COVID-19) extracorporeal membrane oxygenation due to endothelial injury and dysregulation of coagulation, which may increase the risk of thrombotic and bleeding complications. This report was created to describe the authors' single institutional experience, with emphasis on the high rate of intracranial hemorrhage for the first 10 patients with COVID-19 placed on venovenous extracorporeal membrane oxygenation (VV ECMO).DesignCase series, retrospective analysis.SettingSingle institution.ParticipantsTen patients.InterventionsNone.Measurements And Main ResultsPatient characteristics, mortality, stroke rate, and length of stay data were collected in all patients. In addition, laboratory values of D-dimer and C-reactive protein and standard measurements of prothrombin and activated partial thromboplastin time were collected on all patients. Ten patients, each confirmed with COVID-19 via reverse transcription-polymerase chain reaction, were supported on VV ECMO for acute respiratory distress syndrome (ARDS) for a mean duration of 9.4 ± 7 days. Four of 10 patients had hemorrhagic strokes, 3 of which resulted in death. At 30 days after initiation of VV ECMO, a total of 7 survivors included 6 patients discharged from the hospital and 1 patient who remained in the intensive care unit.ConclusionsIn this small study of 10 patients, intracranial hemorrhage was a common complication, resulting in a high rate of death. The authors urge caution in the anticoagulation management of VV ECMO for patients with severe ARDS and COVID-19 patients. Close monitoring of all hematologic parameters is recommended during ECMO support while awaiting larger, multicenter studies to examine the best practice.Copyright © 2020 Elsevier Inc. All rights reserved.

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