Thoracotomy in adults while on ECMO is associated with uncontrollable bleeding

This report details the outcomes of four patients supported by extracorporeal membrane oxygenation (ECMO) who required thoracotomy. All four patients sustained massive bleeding as a result of the operative intervention, which was not controllable in three of the patients who subsequently died. This experience has led us to review the literature of anticoagulation management of patients on ECMO so we can alter our own protocols and allow safer operative intervention in the future.