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Updated: Mar 28, 2026

Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Vascular Complications Arising from Hemostasis with Manual Compression Following Extracorporeal Membrane Oxygenation
Hye Ju Yeo1, Hyeong Jin Kim2, Jin Ho Jang2
1Department of Pulmonology and Critical Care Medicine, Pusan National University Yangsan Hospital, Medical Research Institute of Pusan National University, Yangsan-si, Republic of Korea.
Background:
We evaluated the vascular complications and success rate of manual compression in achieving hemostasis and access site closure after transfemoral arterial extracorporeal membrane oxygenation (ECMO) decannulation.
Methods:
Between February 2010 and July 2014, 63 patients who underwent veno-arterial ECMO were retrospectively studied. Patients who developed postprocedural vascular complications after manual compression were identified, and the hemostasis success rate was evaluated.
Results:
The overall manual compression success rate was 95.2%. Eleven patients (17.5%) developed vascular complications: hematoma (more than 5 cm) occurred in six patients (9.5%) who were treated with repeat manual compression. Retroperitoneal bleeding occurred in one patient, requiring abdominal hematoma evacuation surgery. One patient (1.6%) developed access site bleeding, requiring suturing. One patient (1.6%) developed an arteriovenous fistula (AVF). Two patients (3.2%) had a pseudoaneurysm, of whom one was treated with sclerotherapy in the femoral artery; the other patient and the AVF patient were treated with repeat manual compression. The hematoma rate was significantly higher in patients with an activated partial thromboplastin time (aPTT) >56, and in whom dual antiplatelet drugs were used (OR: 11.55, 95% CI: 1.32-100.92, p = 0.027; OR: 8.17, CI: 1.61-41.46, p = 0.011, respectively).
Conclusion:
The use of dual antiplatelet drugs and a higher aPTT can lead to an increased risk of post-procedural vascular complications. Therefore, manual compression should be applied cautiously after the correction of coagulopathy factors such as activated clotting time (ACT), aPTT, and platelets.
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Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...

