*1.10.2 Thrombosis and thromboembolism*

Systemic thromboembolism may occur due to thrombus formation in the arterial side of VA-ECMO circuit and has devastating consequences. Venous thrombosis may develop at the cannulation site with the development of deep venous thrombosis and pulmonary embolism. Arterial thrombosis may lead to limb ischemia and gangrene. To prevent complications, circuit should be regularly inspected for signs of clot

**Figure 2.** *Complications of VA-ECMO.*

*Overview of Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support… DOI: http://dx.doi.org/10.5772/intechopen.105838*

formation at the connectors site, tubing, and oxygenator, and monitoring the pressure gradient across the oxygenator. A sudden change in the pressure gradient suggests the development of thrombus. Large or mobile clots require immediate circuit or component exchange.

### *1.10.3 Neurological*

The incidence of neurologic injury varies from 10% in adult respiratory failure patients to 50% in patients with ECPR. The types of neurological injury included coma, encephalopathy, anoxic brain injury, stroke, brain death, and myoclonus.

#### *1.10.4 Cannulation-related*

These complications are uncommon (<5%) and include vessel perforation with hemorrhage, arterial dissection, distal ischemia, and incorrect location (e.g., venous cannula within the artery).

#### *1.10.5 Heparin-induced thrombocytopenia*

Heparin-induced thrombocytopenia (HIT) can occur in patients receiving ECMO. When HIT is proven, the heparin infusion should be replaced by a nonheparin anticoagulant. We favor switching to bivalirudin in our institute.

#### **1.11 VA ECMO-specific complications**


#### **1.12 Contraindication to VA-ECMO**

For severe PAD (percutaneous only) and moderate or severe aortic regurgitation, although ECMO provides the highest level of support, it can lead to significant complications including pump thrombosis, bleeding, ischemic limbs, and Harlequin syndrome.
