Post-decannulation management of residual ECMO circuit blood: a national cross-sectional survey in China

Abstract Background Post-decannulation management of residual extracorporeal membrane oxygenation (ECMO) circuit blood is an under-standardized issue in critical care and perioperative patient blood management. Whether residual circuit blood should be discarded, directly reinfused, collected in a storage bag, or processed with a blood cell salvage device remains unclear. This national survey assessed current practices, perceived safety concerns, and barriers to standardized residual circuit blood management in Chinese ECMO centers. Methods Survey invitations were distributed between November and December 2025 to 930 ECMO centers that had been in contact with the Chinese Society of Extracorporeal Life Support by the end of 2024, and the dataset was locked after the predefined response period. Responses were analyzed descriptively; exploratory subgroup comparisons used chi-square tests. Results After exclusion of duplicates, 482 valid center-level responses were analyzed (response rate, 51.8%). Direct discard was the predominant primary handling method (67.6%). Reinfusion-related experience was less common: 9.1% of centers had used a blood cell salvage device, 17.8% had used a blood storage bag, and 29.2% had attempted direct reinfusion. Blood conservation was the most frequently perceived benefit (91.5%). Only 8.7% considered reinfusion very low risk with no specific concern; the most common specific concerns were infection (73.7%), gas or thrombotic embolism (47.3%), inflammatory response exacerbation (41.7%), hemolysis-related hemoglobin release (38.0%), and coagulation disorders (26.6%). Volume overload was selected by 8.3%. The patient’s blood volume status was the leading decision factor (72.2%). Approximately 80% of centers cited lack of standardized procedural guidance and high-quality evidence. An individualized risk-stratified strategy was the most frequently selected ideal approach (46.3%). In unadjusted exploratory analyses, higher-volume centers were associated with lower reported direct disposal and greater cell salvage capability. Conclusions This national survey identifies substantial practice variation and an apparent discordance between perceived blood-conservation benefits and routine handling practices. The key issue is not whether residual circuit blood should be universally reinfused, but how it can be assessed, processed, monitored, or discarded within a structured risk-assessment framework.