Viscoelastic Testing on Venoarterial Extracorporeal Membrane Oxygenation: Need or Greed?

Extracorporeal life support (ECLS) is a life support modality that is being used in life-threatening cardiac and/or respiratory failure; in neonates, children, and adults. The risk of bleeding and other coagulation-related issues is unavoidable. Hence, while conducting ECLS, a patient-tailored approach is better than the generalized approach for bleeding management. There are no established guidelines for heparin use and its monitoring during ECLS in a bleeding patient on VA ECMO. Likewise, heparin and its adjuncts, though mentioned in the literature, have no consensus on what exact steps to follow in an adverse condition. Having a protocol for anticoagulation and its monitoring is of paramount importance in any center practicing ECLS. This review aims to seek the incidence of bleeding and thrombosis while on ECMO with the use of routine anticoagulant heparin and justify the need for the use of viscoelastic tests on VA ECMO.