ECMO-associated hemolysis: Advances in mechanisms and clinical management

Extracorporeal membrane oxygenation (ECMO) is a crucial life-support technology in critical care. However, ECMO can lead to severe complications, including hemolysis, and the underlying causes and molecular mechanisms of hemolysis are not well understood. This review systematically synthesizes prior research to elucidate hemolytic mechanisms and associated complications in ECMO therapy. We systematically investigated the effects of mechanical damage, material biocompatibility, blood component interactions, and clinical treatment on erythrocyte damage during ECMO support. This paper integrates biomechanical quantification of shear stress thresholds, and material science evaluation of surface-protein adsorption dynamics, and clinical observations of hemolysis patterns, conducted from biomechanical, material science and clinical perspectives. Based on these insights, we propose optimal ECMO design strategies and clinical measures to mitigate hemolysis. We further propose integrating intelligent biosensors, hemodynamically optimized circuits, and next-generation biomaterials to enhance real-time biocompatibility monitoring and therapeutic management. • Leukocytes and platelets drive ECMO-induced hemolysis. • Mechanistic insights guide precision anticoagulation. • Current ECMO hemolysis status comprehensively reviewed. • AI, coatings, and protocols improve ECMO outcomes. • Multicenter trials and precision medicine cut hemolytic risk.