Daily Assessment of Bleeding:

Because patients on ECMO are on systemic anticoagulation, they are at increased risk of bleeding. In addition to hemodynamic monitoring and frequent CBCs, part of the daily assessment should include screening for:

  • Intracranial bleeding: Any new focal neurologic deficit, or decreased level of consciousness should prompt further evaluation for potential intracranial bleeding.
  • GI Bleeding: The patient should be monitored for the presence of hematemesis and coffee-ground emesis, as well as hematochezia and melena.
  • Intrathoracic bleeding: In patients who have had cardiac or thoracic surgery, high chest tube outputs should raise suspicion for a hemothorax.
  • Pericardial bleeding: In the presence of hemodynamic instability, pericardial bleeding needs to be ruled out (usually by transthoracic or transesophageal echocardiography).
  • Retroperitoneal bleeding: Retroperitoneal bleeds are often occult, and in patients with a drop in hemoglobin and no obvious bleeding source this should be considered.
  • Cannulation site bleeding: Careful attention should be paid to the area around each cannulation site, monitoring for swelling or oozing.
  • Surgical site bleeding: Patients who have had a surgical procedure developing a bleed around their surgical site, and this should be monitored.

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