Review on Anticoagulant-free ECMO

Extracorporeal membrane oxygenation (ECMO) is an advanced life-saving therapy that has been used in recent years for the treatment of severe respiratory failure or cardiac failure.The use of extracorporeal circuit exposes blood to non-biologic, thrombogenic surfaces, and therefore, ECMO protocols recommend systemic anticoagulation for patients on ECMO.Extracorporeal membrane oxygenation is a complex procedure in which anticoagulation is given ideally to balance between prevention of thrombosis and control of bleeding.The presence of active bleeding or coagulopathy in critically ill patients makes the choice of the anticoagulation strategy very challenging.In patients with active or high risk of major bleeding, standard systemic anticoagulation is not possible and in such situation the prospect of anticoagulation-free ECMO is a viable option.Although only limited data is available on the safety and efficacy of this practice, many centers adopt low and anticoagulant-free ECMO protocols in patients with high bleeding risk.In this literature, we have discussed the clinical prospects of anticoagulation-free ECMO.